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2. First Name*
3. Last Name*
5. Address*
7. City*
9. Phone Number*
10. Email Address*
12. Are you 18 years of age or older?*

    1. Yes
    2. No

    CFA students must be 18+ years old to participate.
13. Do you have any special needs that would require accommodations in order for you to participate in this program?

    1. Yes

    1. No
15. Please Explain
17. Why do you wish to participate in the Citizens Fire Academy?*
19. How did you find out about the Citizens Fire Academy?
21. Thank you for your interest!

    The purpose of the Winston-Salem Fire Department Citizens Fire Academy is not to train an individual to be a firefighter, but to produce informed citizens, and build long-lasting relationships with residents in our community.

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23. Submit

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