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2. Name*
3. Age*

   Under 18 will require guardian/parent approval

5. Address*
6. City/Zip*
8. Phone Number*
9. Email Address*
10. Occupation:*
12. Preferred Days*

    Select at least two days.

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
    6. Saturday
    7. Sunday
13. Time you wish to ride along*

    Must start after 10am and be completed before 5pm. 

    No more than 7 hours total.

    No overnights.

14. Preferred Station:*

    Choose both if no preference.

    1. Station 1 (115 Second Street)
    2. Station 2 (370 Airport Blvd.)
16. What do you hope to gain from the ride-along?*
18. How did you become aware of this program?
20. Reason for Ride-Along:*

    1. Firefighter Applicant
    2. EMT Student
    3. Fire Technology Student
    4. High School Student
    5. OTHER
21. Reason for Ride Along: OTHER*

    If you selected Other, please tell us the reason for your Ride-Along request.

    If you made a selection, please enter N/A

Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit Submit and Print

* indicates a required field