Applicant Name
Street Address City State Zip
Phone
Your Email (required)
Age
Date of Birth
Current School
Parents or Legal Guardian Name
Parent or Guardian Phone
In case of emergency, and Parents cannot be reached, who should be notified? Relationship Phone
Do you have any medical conditions or allergies that CFPD should be aware of? YesNo If Yes, please describe
Are you taking any medications that CFPD should be aware of? YesNo If Yes, please list medications
Physician Name
Physician Phone
Please list any extra-curricular activities with school or other organizations?
How did you hear about the Cary Fire Protection District Cadet Program?
Why do you want to participate in the Program?
What do you feel you could bring to the Program?
Cadets are required to attend training as part of the program. Training includes the once per month cadet meetings, every other Tuesday night training and other training dates. Do you believe you will be able to attend, at minimum, 50% of the training available? YesNo Please Explain, if appropriate:
Applicant Signature: Enter your full name:
Your electronic signature certifies that the information you provide on this application is accurate and true. By entering your name into the above field, you are legally signing the document.
