Cadet Firefighter Program Application

Applicant Information

Applicant Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Applicant Phone

Applicant Email

Do you have your parent’s permission to apply to be a Cadet Firefighter?

Yes
No

Parent / Guardian Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent / Guardian Phone

Parent / Guardian Email

Emergency Contacts

Name

First Last

Phone

Relation

Name

First Last

Phone

Relation

Medical Information

Doctor Name

Doctor Phone

Hospital Name

Hospital Phone

Medical Conditions

Allergies

Do you take any medicaiton?

Yes
No

Please list medication and what it is for.

Have you ever been arrested, ticketed, fined, etc.? (Felonies, traffic tickets, misdemeanors, etc.)

Yes
No

Please list date(s) and what the charge(s) was/were.

What interests you the most about becoming involved with the Mukwonago Fire Department?

Please list other activities, in detail, that you are involved in (sports, volunteer work, church, etc.).

Parental Consent

My son/daughter has my permission to be a Cadet Firefighter with the Mukwonago Fire Department.

Parental Signature*

Contract of Understanding

My son/daughter and I have read ALL of the Cadet Firefighter Guidelines and understand the guidelines set up to outline the purpose of the Cadet Firefighters. My son/daughter and I understand that Cadet Firefighters serve as supporters of the Mukwonago Firefighters to learn the basics of firefighting and to prepare to become a full member at the age of 18.

My son/daughter and I understand that Cadet Firefighters are to follow all instructions from members of the Mukwonago Fire Department and that the general standard of conduct is to act in the manner of a professional.

My son/daughter and I understand that he/ she is expected to be courteous and respectful of other members (Cadet and Regular) and to all citizens as they are representing the Mukwonago Fire Department.

My son/daughter and I understand there is a “zero tolerance” policy regarding drug and alcohol use. My son/daughter and I understand that by signing this Contract of Understanding we are declaring that any violation of the guidelines is grounds for immediate dismissal.

My son/ daughter and I understand that any acts that violate the guidelines and that are illegal by state and local law will be referred to the Mukwonago Police or Waukesha County Sheriff’s Department.

Parental Signature*

Applicant Signature*

Acknowledge Receipt of Guidelines I acknowledge that my son/daughter and I have received a copy of the Mukwonago Fire Department Cadet Firefighter Pro¬gram Guidelines and have reviewed them prior to signing these documents.

Applicant Signature*

Parental Signature*