DIAL 911 FOR EMERGENCIES

DIAL 911 FOR EMERGENCIES

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Events Calendar

May 2018
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Jr. Firefighter App
Junior Firefighter Application
  1. Thank you for your interest in joining our Junior Firefighter program. Please take a moment to read through the following information and reach out to us using the "Contact Us" option if you have any questions.

    The program is open free of charge to all students age 13 through 18 who attend school in the Little Axe School District or a surrounding area in Eastern Cleveland County, Western Pottawatomie County or Southeastern Oklahoma County. This program is registered with the National Volunteer Fire Council.

    Participation will require signature of a parent or legal guardian at the time of attending your first meeting.

    Thank you for your interest in becoming a Junior Firefighter. We look forward to meeting you!
  2.  
  1. Position:(*)
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  2. First Name(*)
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  3. Middle Name(*)
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  4. Last Name(*)
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  5. Home Phone Number(*)
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    Numbers only, no dashes.
  6. Mobile Phone Number(*)
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    Numbers only, no dashes.
  7. Email Address:(*)
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  8. School Attended:(*)
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  9.  
  1. PERSONAL INFORMATION:
    * indicates a required field.

  2. Blood Type
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  3. Date of Birth(*)
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    Use calendar to enter your date of birth (MM/DD/YYYY)
  4. Street Address(*)
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  5. City(*)
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  6. State(*)
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  7. Zip(*)
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  8. Height(*)
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  9. Weight(*)
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    lbs.
  10. Shirt Size(*)
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  11. Pant Size(*)
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    ( Waist / Inseam )
  12. Shoe Size(*)
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  13.  
  1. PARENT or GUARDIAN CONTACT INFORMATION:
    Please include any specific instructions in the Emergency Instructions box.
    * indicates a required field.

  2. Parent Name(*)
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  3. Parent Home Phone(*)
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    Numbers only, no dashes.
  4. Parent Mobile Phone(*)
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    Numbers only, no dashes.
  5. Emergency Instructions
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  6. On the next page you will be required to answer a series of pre-screening questions. Select "Next" to continue...
  7.  
  1. List here any additional information you would like to add.

    Enter N/A if nothing to add.

  2. Additional Info:(*)
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  3.   RefreshInvalid Input
 
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