Applicant Name First * Middle Last * Address Street Address * Address Line 2 City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming 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 * Middle Last * Address Street Address * Address Line 2 City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP Code * Parent / Guardian Email * Birth Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Parent / Guardian Phone Emergency Contacts First Name Last Name Phone Relation Emergency Contacts First Name Last Name Phone Relation Medical Information Doctor Name Doctor Phone Hospital Name Hospital Phone Medical Conditions Allergies Do you take any medicaiton? Yes No Have you ever been arrested, ticketed, fined, etc.? (Felonies, traffic tickets, misdemeanors, etc.) Yes No 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 ConsentMy son/daughter has my permission to be a Cadet Firefighter with the Mukwonago Fire Department. Parental Signature * Acknowledge Receipt of GuidelinesI acknowledge that my son/daughter and I have received a copy of the Mukwonago Fire Department Cadet Firefighter Program Guidelines and have reviewed them prior to signing these documents. Parental Signature * Applicant Signature * Contract of UnderstandingMy 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 * Leave this field blank
