Date of Application MM slash DD slash YYYY First Name* Last Name* Email* Phone*NJ Division of Fire Safety # Address City State Zip Are you interested in:Class RegistrationAcademy Use RegistrationCompany* Department Company Address* Company Phone*Title of Class Class Start Date MM slash DD slash YYYY Chief’s Name Chief’s Email Chief's NumberIf you are requesting use of the facility, select all that apply: Classroom 17 Classroom 18 Classroom 20 Multipurpose Room Conference Room Truck Bay Maze Smoke House Burn Room Propane Props Natural Gas Props (currently out of service)” Extrication Pad Grounds Other Brief Description of UseCheckbox You, the attendee, shall hold harmless and indemnify Toms River Fire Co. Districts 1 & 2, its officers, agents and employees for damage to persons and/or property arising from the actions of its attendees at the Toms River Fire Academy, except as such injuries and damages are caused by the gross negligence of Toms River Fire Co. Districts 1 & 2 or its employees or agents. All fees must be paid prior to the issuing of the Course Certifications of Completion. PhoneThis field is for validation purposes and should be left unchanged.