Cadet Application

Name*

First Last

Phone

Address*

Street Address Address Line 2 City State ZIP Code

Date of Birth*

Age Today*

Please enter a number from 14 to 17.

Gender*

Male
Female

Email*

Do you have a High School Diploma or GED?*

Yes
No

If yes, School Name & address*

Are you currently enrolled in...*

High School
College

Select one.

Which school or college do you attend?*

What is your GPA?*

Have your participated in the KCR Cadet Program before?*

Yes
No

Where?*

Where did you hear about the Cadet Program?*

Please give a brief description of where you heard about the Cadet Program.

Do you have a TN Driver’s license?*

Yes
No

DL#

Additional Info

List any extracurricular activities*

Do you have any physical limitations, medical considerations, health concerns or special needs?*

****Special needs will not automatically disqualify you from participation with the Cadet Program.****

Have you ever been arrested and/or convicted of ANY crime other than traffic violations?*

Yes
No

If yes, please explain. Attach any documents if necessary.*

List all traffic citations received in the last 3 years & the outcome of these violations.*

Emergency Contact Info

In the event of an emergency or serious injury/ illness, this information will be used to notify your parent/guardian obtain consent if needed.

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Primary Phone Number*

Secondary Phone Number

Waiver and Release of Liability

Waiver and Release of Liability*

Please use the following link, or copy and paste into your browser, to print the Waiver and Release of Liability for your parent(s) to complete. https://knoxcountyrescue.org/wp-content/uploads/2021/01/Cadet-waiver.pdf

By checking this box, I confirm that I have printed the below Waiver and Release of Liability for my parent(s) to complete.

Cadet Program Application

Additional Info

Emergency Contact Info

Waiver and Release of Liability

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