Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone *At which station would you like to schedule your ride-along? *Choice 11Station 50Station 51Station 53Station 54Station 57Station 58Station 59Station 61Station 62Station 63E-540Any station – Battalion 3 (Prescott Valley area)Any station – Battalion 6 (Chino Valley area)Please select the station you would like to ride-along with.Reason for Ride-Along *Are you currently enrolled in Fire or EMS courses? *Choice 1Yes – EMTYes – CEPYes – FirefighterNoName of school/programPlease enter the fire/ems program in which you are enrolled.Are you under eighteen (18) years of age? *Choice 1YesNoParent Guardian NameIf under 18 years of age, please enter parent/guardian name.Parent-Guardian Email AddressIf under 18 years of age, please enter parent/guardian email address.Submit
