Ride-Along ApplicationFull Name (required)Date of Birth (required)Home Address (required)Phone Number (required)Type (required)HomeCellEmail AddressOrganization Represented (If applicable, N/A if none) (required)Date of Ride-Along RequestedReason for Ride-Along (required)Have ever been arrested? (required)YesNoIf Yes, list offense, location, and dateIn the event of an emergency, name of contact (required)Emergency contact phone number (required)Relation (required)I have read and understand the Rules of Conduct and Procedures for the Mazon Fire Department Ride-Along Program? (required)YesNoThere was a problem saving your submission. Please try again later.Please wait while your submission is being saved...Submitting...SubmitThank you, your submission has been received.
