P. O. Box 3063, SHERMAN, TX 75091 Phone: 903-564-3862. Fax: 903-564-3017
HAZ-CO FIRE TRAINING ACADEMY- Bill Palya, Coordinator
Choose: DAY CLASS or NIGHT CLASS (PLEASE CIRCLE ONE)
NAME__________________________________________D.O.B.________________AGE________
Last First M.I.
SOC.SEC.#_______________________________________SEX (CIRCLE ONE) MALE FEMALE
HEIGHT___________WEIGHT___________HOME PHONE_______________________________
(AREA CODE)
HOME ADDRESS_______________________CITY____________ST_______ZIP_____________
CURRENT EMPLOYER____________________________WORK PHONE__________________
CELL PHONE:___________________EMAIL ADDRESS:_______________________________
EDUCATION: CIRCLE THE HIGHEST LEVEL ACHIEVED
A. G.E.D. D. COLLEGE-BA
B. HIGH SCHOOL E. COLLEGE-MASTER
C. COLLEGE-ASSOC. F. COLLEGE-DOCTORATE
HAVE YOU HAD ANY FIRE TRAINING BEFORE? EXPLAIN
__________________________________________________________________________________
DO YOU HAVE A CURRENT AMERICAN HEART ASSOCIATION CARD?_____________________
WHERE DID YOU HEAR ABOUT HAZ-CO FIRE ACADEMY?______________________________
HAVE YOU APPLIED TO OTHER FIRE ACADEMIES? (CIRCLE ONE) YES NO
IF YES, WHERE?__________________________________________________________________
BY THE FIRST DAY OF CLASS, YOU MUST PROVIDE US WITH A COPY OF A MEDICAL PHYSICAL
AND PULMONARY TEST.
ALL TUITION IS DUE BY THE FIRST DAY OF REGISTRATION.
CLASS IS LIMITED TO 25 STUDENTS. A DEPOSIT OF $500.00 PRIOR TO REGISTRATION WILL SECURE ONE
OF THE FIRST 25 SPOTS. ALL OTHERS WILL BE FIRST COME, FIRST SERVE.
SIGNATURE OF APPLICANT ______________________________________ DATE ____________________
T shirt size: S M L XL 2XL (circle one)