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2. First Name
3. Last Name
5. Email Address
6. Phone Number
8. Address
10. City
11. State
12. Zip
14. Emergency Contact Full Name

    Please provide a contact who will be available during the duration of the program.

15. Phone Number
17. Shirt Size
    -- Select One --SmallMediumLargeX-LargeXX-LargeXXX-Large
19. Why do you wish to attend the Citizens Fire Academy?
21. Are you related to anyone employed by the Hinesville Fire Department?

    1. Yes
    2. No
22. If yes, who?
24. Have you ever been convicted of a felony within the last 10 years?

    1. Yes
    2. No
25. If yes, please provide details:
27. Do you have any health issues that would require a reasonable accommodation to participate in the program?

    1. Yes
    2. No
28. If yes, explain:
30. Academy classes are scheduled for five consecutive Wednesday nights, from 6 – 8 p.m. Excluding emergencies, can you attend all classes?

    1. Yes
    2. No
31. If no, explain:
33. General Liability Waiver Hinesville Fire Department

    I acknowledge that I have voluntarily applied to participate in the Citizens Fire Academy 2025 program organized by the Hinesville Fire Department, located at 304 S. Commerce Street, Hinesville, GA 31313.

    While I understand every effort will be made to ensure a safe experience, I also understand that certain risks cannot be entirely eliminated. I voluntarily accept and assume full responsibility for any risk of property damage, or personal injury, that may arise from participation in this program.

    As a condition of my involvement, I agree that neither the City of Hinesville, the Hinesville Fire Department, nor any of its members, employees, or representatives shall be held liable for any injury, loss, damage, or expense incurred by me or my property during the program.

    Photo & Media Release: I grant permission for the use of photographs, video recordings, or other media featuring the minor participant for promotional or other lawful purposes by the City of Hinesville or Hinesville Fire Department, without expectation of compensation.

    By submitting this online application, I confirm that I have read and fully understand this application and waiver. By submitting the application and waiver, voluntarily, intending to release and hold harmless the City of Hinesville from any and all liability associated with my participation in this program.

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35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit Submit and Print

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