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Montgomery County Fire Academy Course Registration Form

  1. **NOTE: You must be 18 years of age or older to use this online registration form.**

    Individuals under the age of 18 must download and submit a traditional registration form (parent/guardian signature required).

  2. Student Name
  3. First three letters of last name & last four digits of social security number

  4. Make-up?
  5. New address, email, or phone*
  6. I grant to Montgomery County Fire Academy, the right to take photographs of me in connection with the above-identified event.  I authorize Montgomery County Fire Academy, its assignees and transferees to copyright, use and publish the same in print and/or electronically.

    I agree that Montgomery County Fire Academy may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

  7. Acknowledgement*
  8. I voluntarily assume all risk of loss, damage, illness or injury that I may sustain while participating as a student in Montgomery County Fire Academy activities.

    I release the County of Montgomery and its officers, agents, and employees from any and all claims, demands, and causes of action on account of any injury or loss which may occur during my participation in Montgomery County Fire Academy activities, through negligence, omission, default or other action of any person or organization associated with such activities.

    Individual Insurance: The County of Montgomery is not authorized to provide travel, medical, or Health insurance for students. You are advised to obtain appropriate insurance on an individual basis. If you are presently insured you should check your policy to assure yourself of sufficient and appropriate coverage.

  9. Acknowledgement*
  10. Leave This Blank:

  11. This field is not part of the form submission.