2018 Secondary Fire Academy - Application

Please complete all of the fields.

* Application ID NO (Teacher or School Career Coordinator to Supply this number)
* Student Last Name
* Student First Name
* Student Address
Address
Country Province/State
City Postal/Zip Code
* Student Email
* Student Phone Number
- -
* Student Age
* Select First choice of the Session Dates.
  • March 19 - 23
  • March 26 - 30
* Select Second Choice of Session Dates.
  • March 19 - 23
  • March 26 - 30
* Are you a Canadian Citizen/Landed immigrant?
  • Yes
  • No
If no (Please Specify)
* BC Driver's License No.
* Class
* Any Infractions or Tickets or Accidents
* Do you have any illness, physical or emotional disability that would affect your participation in the Secondary Fire Academy?
  • Yes
  • No
If yes, Please explain:
* Do you wear or require corrective lenses (glasses or contact lenses)?
  • Yes
  • No
* Have you been convicted of a criminal offence?
  • Yes
  • No
* If yes, please explain
* List any skills/attributes you have to offer
* School Name
* School Career Coordinator Name
* School Career Coordinator Phone Number
- -
* School Career Coordinator Email
* Emergency Contact Name
* Emergency Contact Phone Number
- -
* Parent/Guardian Name
* Parent/Guardian Phone Number
- -
* Parent/Guardian Cell Phone Number
- -
* Completed and signed Parent/Guardians Permission and Liability Waiver
  • Yes
  • No
* I hereby certify that the information I have provided in this application is true and complete to the best of my knowledge. I understand that if any of this information is found to be untrue, the application shall be considered void.
  • Yes
  • No
* I agree that by clicking on the "Submit" button of this application I am effectively signing my application.
  • Yes
  • No