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2. Name*
3. Email Address*
5. Address*
7. City
8. State
9. Zip Code
11. Phone Number*
12. Date of Birth *Must be 18 years old*
    Date of Birth *Must be 18 years old
14. T-Shirt Size*
16. Are you aware of any medical conditions which would prevent you from safely performing Academy activities? If you require any ADA accomodations please let us know
18. List any trainings you have received in the Medical or Fire service, including first aid or CPR. (No previous training is required)
20. Emergency Contact Name*
21. Emergency Contact Phone Number*

23. Once submitted, you will receive confirmation via email within 2 business days. On your first day of class you will be asked to sign a wavier. 

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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field