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2. 
3. San Marcos Fire Department Middle School Junior Fire Academy Application
   Session 2: Elementary School (Grades 6,7,8) June 22-26 Elementary School Junior Fire Academy
5. 1 Application Per Child
9. Child's First Name*
10. Child's Last Name*
11. Child's Gender*
    -- Select One --MaleFemale
13. Child's Date of Birth*
    Child's Date of Birth
14. Child's Age on June 15, 2020*
    -- Select One --11121314

    Child must be 11-14 Years Old to participate in the elementary school portion of SMFD Jr. Fire Academy Session 2 which is for middle school students.
15. T-Shirt Size
    -- Select One --Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XL
17. Name of School
18. Grade Level Just Completed*
    -- Select One --6th7th8th

    This 2nd session is for children who just completed 6th, 7th, 8th grade.
20. Has the child attended previous camps?*

    1. Yes
    2. No
21. If yes, which year/s?
23. Does the child's parent/s work for the City of San Marcos?*

    1. Yes
    2. No
24. Does the child's parent work for the San Marcos Fire Department?*

    1. Yes
    2. No
26. Health Information: Health Conditions*
    Please list any health conditions that will require special accommodations. If none, please write None.
28. Health Conditions: Medicine*
    Please list any medicines that your child regularly takes that will require special accommodations or administering while at JFA. If none, please write None.
30. Health Conditions: Food Allergies*
    Please list any food allergies that will require special accommodations. If none, please write None.
34. Name of Legal Guardian/Primary Contact*
35. Email Address*
    *Primary Form Of Communication
37. Street Address*
39. City*
40. State*
41. Zip*
43. Cell Phone Number*
    Primary Contact Direct Number
44. Daytime Phone Number*
48. Are you interested in volunteering at JFA?*

    1. Yes
    2. No

    If yes, we'll need your birthday to run the background check.
49. If interested in volunteering at JFA, please put down your birthday.
    If interested in volunteering at JFA, please put down your birthday.
53. 1st Emergency / Alternative Contact*
    First and Last Name
54. Relationship*
55. Phone Number*
57. 2nd Emergency / Alternative Contact*
    First and Last Name
58. Relationship*
59. Phone Number*
61. 3rd Emergency / Alternative Contact*
    First and Last Name
62. Relationship*
63. Phone Number*
67. Guardian Initials*
68. MINIMUM AGE AGREEMENT
    I, the undersigned, certify that my child is at least ELEVEN (11) years old and has completed sixth grade. I understand that falsification of any information on this form may disqualify my child from the program.
70. Guardian Initials*
71. JFA PICK UP & DROP OFF AGREEMENT
    Camp times are from 8am-2pm each day. DROP OFF: Parents can drop their children off between 7:30am-8am. PICK UP: Children will need to be picked up at 2pm each day. Staff will stay until 2:30pm.
73. Guardian Initials*
74. LIABILITY RELEASE
    In consideration for the acceptance of my child’s registration in the Junior Fire Program, I hereby release THE CITY of SAN MARCOS, the SAN MARCOS FIRE DEPARTMENT, their agents, employees, firefighters, and servants from ANY and ALL damages and injuries, which may occur while my child is in the Junior Fire Academy Program, including transportation. I certify that I have the legal authority to execute this release on behalf of my child.
76. Guardian Initials*
77. PERMISSION TO ATTEND:
    By signing this document I acknowledge that I have given my authorization for my child to attend the Junior Fire Academy Program and travel when needed.
79. Permission to Photograph*

    1. YES: I give permission to photograph
    2. NO: I do NOT give permission to photograph
80. PERMISSION TO PHOTOGRAPH:
    As part of the Junior Fire Academy, a group photo of the children will be taken and placed in local newspapers. There may also be media coverage of the academy as well as video to be used by the Fire Department. I authorize the photography of my child for this purpose.
84. Parent / Legal Guardian First and Last Name*
    By typing my name, I am electronically signing this application. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.
85. Date *
    Date

    Date
Leave This Blank:


87. 1. Receive an email copy of this form.
88. Email address

    This field is not part of the form submission.

89. Submit Submit and Print

* indicates a required field