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2. 2023 Junior Citizen's Fire Academy Application
3. 
5. Please have your child's Essay Question response ready to paste into the appropriate field at the bottom of this application. The writing prompt is: What is the biggest safety concern for your age group and how would you help improve the problem? (Max 400 words)
7. Is your child trying to attend with a friend? Please provide the friend's name here:
   We will do our best to accommodate this request.
9. 2023 Jr. CFA Date Selection *

   Please select which week you prefer to attend.

   1. Session 1 - June 5-9
   2. Session 2 - June 12-16
11. About the Applicant
    Please fill out information below
13. Date of application completion*
    Date of application completion
15. Child's First Name*
16. Child's Last Name*
17. Child's Preferred Name for ID Badge*
19. Gender*

    1. Female
    2. Male
20. Child's Shirt Size

    1. Youth XLarge
    2. Adult Small
    3. Adult Medium
    4. Adult Large
    5. Adult XLarge
    6. Adult XXLarge
    7. Adult XXXLarge

    Choose one
22. School*
23. Grade Level as of April 2023*

    Course is open to those who are currently in 6th, 7th, 8th grades.

25. Child's Address*
26. City*
27. Zip*
29. Child's Mobile Phone *
30. Child's Home Phone
32. Primary Parent / Guardian Name *
33. Address (Parent / Guardian ) If different than above
35. Cell Phone (Parent / Guardian)*
36. Email (Primary Parent / Guardian)*
37. Re-type Email Address *
39. Employer (Primary Parent / Guardian)
40. Work Phone (Primary Parent / Guardian)
42. Name of Second Parent/Guardian*
43. Cell Phone (Second Parent / Guardian) *
44. Email (Second Parent or Guardian)*

    We must have a second person on the notification list to avoid missed informational emails.

46. Emergency Contact Name (other than a parent)*

    Other than primary or secondary parent listed above.

47. Emergency Contact Address *
48. Emergency Contact Cell Phone *
50. Does this child qualify for free or reduced lunch program?*

    1. Yes
    2. No
51. Name of person picking up this child each day*
52. Cell Phone for person picking up child.
54. Medical Information
    NOTE: All medical emergencies will be treated as such and will be attended to by the Frisco Fire Department as deemed necessary by academy personnel, instructors, or coordinators.
56. Applicant (Child's) Medical Information
58. First Name*
59. Middle Name *
60. Last Name*
62. Please list any medical conditions, allergies or special needs the child has:
64. List all medications taken by the child:
66. Is the child required to take medication during the hours of 9:00 AM and 3:00 PM?*

    1. Yes
    2. No
67. If yes, what is the medication and the required dosage?
69. Is the child able to administer his/her medication?

    1. Yes
    2. No
71. If no, please explain:
73. Physician Name *
74. Physician Phone *
76. Dentist Name
77. Dentist Phone
79. Rules of Behavior

    1.Student will be expected to maintain a mature and respectful attitude toward classmates and instructors. 2.Students will adhere to a strict “no touch’ policy, much like those of school rules. 3.Students are expected to keep up with their personal belongings and should limit what they bring to class (notebook, lunches, water bottle, etc.) 4.Cell phones and any other electronic devices will not be allowed to be out or in use during class time. 5.Drawstring bags and backpacks are allowed. 6.Students will be expected to participate in all class activities. (If student is unable, Instructors should be given written notice of student’s physical limitations prior to the start of the academy). Violations of the rules of behavior may result in removal from the class for the day. Subsequent violations may result in expulsion from the academy.

81. By checking “YES” you are indicating that you have read and agree to the terms and conditions above. *

    Parent / Guardian :

    1. Yes
83. ESSAY QUESTION
    To be completed by the child applying for Jr CFA.
85. What is the biggest safety concern for your age group and how would you help solve the problem?*
    Please write a maximum of 400 words to answer the essay question.
87. Program Information

    The academy is one week long and will take place at Central Fire Station/Safety Town, 8601 Gary Burns Drive in Frisco, between the hours of 9:00 AM to 3:00 PM Monday through Thursday and 9:00 AM and 1:30 PM on Friday; A graduation ceremony, which parents are invited to attend, will be at 12:00 p.m. noon on Friday. DROP OFF/PICK UP: Drop Off at the Bus Entrance (covered drive) between Safety Town and Central Fire Station. Enter parking lot for Safety Town off of Main Street. We will have a Frisco Firefighter and volunteer outside starting at 8:30 AM to escort your student to the classroom. Pick up is in the same location as drop off. Please make arrangements to pick up your child no later than 3: 00 p.m. Mon-Thurs and no later than 1:30 p.m. on Friday. Students will be waiting for you to pull up and they will be escorted to their car. If you need to pick up your child early, please go to Frisco Fire Safety Town front office and speak with staff. ATTIRE: Students wear the Jr. CFA t-shirt given out on the first day of the program, shorts and athletic shoes for physical activities they will participate in during the program. WHAT TO BRING: Students will need to bring a disposable sack lunch, water bottle (we will provide one) with name on it and a towel, a notebook (we will provide one) and pen or pencil. Electronic devices (such as cell phones) are not allowed to be used during the class time. We will give the students time during their lunch to look at their phones for parental correspondence. WHAT TO EXPECT: Students will have a designated lunch break and several breaks throughout each day. Students must attend all five days of the academy. Students will be expected to take the program seriously, and follow academy rules, which are similar to school rules. Violations of the rules of behavior may result in removal from the class. If you have any questions, please contact Jr. CFA Staff at 972-292-6350.

89. NOTES:

    Please add any additional information you feel we should know about your child as part of this application.

91. Acceptance to the Program

    You are not admitted to the program until you receive a confirmation email from us. Confirmation emails will go out on FRIDAY MAY 12, 2023. That email will include forms that must be completed,signed and returned prior to the first day of class.

Leave This Blank:


93. 1. Receive an email copy of this form.
94. Email address

    This field is not part of the form submission.

95. Submit

* indicates a required field