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2024 Haines City Citizens Academy

  1. logo of Haines City Seal
  2. Type in your First Name

  3. Type in your Last Name

  4. Type in your street address

  5. Type your city

  6. Type your state

  7. Type your zip code

  8. Type your phone number

  9. Type your email address

  10. Type number of years living in Haines City

  11. Type your occupation

  12. Type your race/ethnicity.

  13. Type your date of birth

  14. Type your food allergies or include if you are vegan or vegetarian.

  15. Type your personal history

  16. Type a list of your memberships in organizations

  17. Type what you hope to learn from the Citizens Academy

  18. I hereby give my permission for the City of Haines City to use any still photography or video footage in which I may appear for whatever purpose(s) deemed appropriate. I do this voluntarily and with the understanding there is no remuneration. In addition, I release Haines City from any liability involved in transporting me to and from Haines City properties.

    Do you agree?

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