Ride-Along Application Full Name (required) Date of Birth (required) Home Address (required) Phone Number (required) Type (required) Home Cell Email Address Organization Represented (If applicable, N/A if none) (required) Date of Ride-Along Requested Reason for Ride-Along (required) Have ever been arrested? (required)Yes No If Yes, list offense, location, and date In 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)Yes No There was a problem saving your submission. Please try again later. Please wait while your submission is being saved... Submitting...Submit Thank you, your submission has been received.
