Total Amount Enclosed. Sissonville Fire & Rescue School Registration 2018

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1 Sissonville Fire & Rescue School Registration 2018 PERSONAL INFORMATION NAME AGENCY ADDRESS CITY STATE ZIP PERSONAL PHONE AGENCY PHONE BIRTHDATE / / T-SHIRT SIZE ADDRESS Firefighter Firefighter Driver / Operator - Pumper WEEKEND ONE Grant Writing for Public Safety Agencies Art of Reading Smoke Fire Ground Communications Rapid Intervention Team (RIT) Awareness Search and Rescue Interviewing Techniques Traffic Incident Management Farm Safety Training Forcible Entry: The Forgotten Art Forensic and Emergency Scene Photography Hiring, Firing, and Retaining Volunteers Night Time Auto Extrication Aggressive Fire Attack with Limited Staffing Critical Incident Stress Management (CISM) NIMS ICS A - Pro Board Challenge - Firefighter B - Pro Board Challenge - Firefighter Public Information Officer - Basic Rapid Intervention Team (RIT) Operations Rope Rescue Level Tactical Emergency Casualty Care (TECC) Vehicle and Machinery Extrication Level Wildland Firefighter (S-130 / S-190) WAIVER OF LIABILITY / MEDIA RELEASE I agree not to hold the Sissonville Fire Department, West Virginia University FSE, WV Public Service Training, its sponsors, or anyone else associated with the Sissonville Fire & Rescue School responsible for any injuries that may occur to me while I am a participant in any class or function. I understand that that nature of fire and rescue classes can be hazardous and I agree to participate in a safe and responsible manner. I also confirm that I am covered under Workers Compensation Coverage at my Department / Agency. I give my consent for my image and likeness to be videotaped, audiotaped, or photographed for use in educational / instructional media, recruitment / outreach media, development media, and newsworthy documentation to be used by the Sissonville FD. I certify that I am at least 18 Years old and do not need permission to participate in any class. SIGNATURE DATE CHOOSE YOUR CLASS SELECTIONS BELOW MULTIPLE WEEKEND COURSES Fire Officer 1 & Hazardous Materials Technician Intro to Technical Rescue (Rescue Core) WEEKEND TWO Basement and Attic Fires Hazardous Materials Awareness Helicopter Fires Swift Water Rescue Awareness Working with K-9 Search and Rescue Teams Commanding the Flood Response Difficult Patient Packaging Scenarios Emergency Response to Alternative Fueled Vehicles Flashover Recognition and Survival Night Time Wilderness Search and Rescue Aggressive Search Tactics Emergency Incident Rehabilitation EVOC - Emergency Vehicle Operations Course Incident Safety Officer Intensive Firefighter Safety and Survival NIMS ICS Politics and The White Helmet Rope Rescue Level UTV / ATV Safety and Rescue Vehicle and Machinery Extrication Level 2 EARLY REGISTRATION IS DUE BY FEBRUARY 19, 2018 TO BE ELIGIBLE FOR A FREE T-SHIRT MAIL PAYMENT AND REGISTRATION TO: SISSONVILLE VFD P.O. BOX Sissonville, WV YOU WILL BE NOTIFIED VIA FOR CLASS CANCELLATIONS OR CLASS CHANGES SECOND / THIRD CHOICES (Enter Class Numbers) Multiple Weekend Courses Weekend One - Friday Weekend One - Saturday Weekend One - Sunday Weekend One - Two/Three Day Courses Weekend Two - Friday Weekend Two - Saturday Weekend Two - Sunday Weekend Two - Two/Three Day Courses NOTE: Enter 2nd / 3rd choices above as needed above. Courses will be selected for you if you do not list them. Total Amount Enclosed Tuition: $ Textbook(s): $ TOTAL: $

2 2018 Sissonville Fire & Rescue School Pricing Sheet Two-Weekend Courses 001 Firefighter 1 o Tuition, Textbook, Access Code, and Facility Fee: $ Firefighter 2 o Textbook: $ Driver / Operator Pumper o Textbook: $ Fire Officer 1 & 2 o Textbook: $ Hazardous Materials Technician o Textbook: $ Intro to Technical Rescue (Rescue Core) Weekend One Courses 100 Grant Writing for Public Safety 8:00 AM o Tuition & Supplies: $ Art of Reading Smoke 102 Fire Ground Communications 103 Rapid Intervention Team (RIT) Awareness 104 Search and Rescue Interviewing Techniques 105 Traffic Incident Management 110 Farm Safety Training

3 111 Forcible Entry: The Forgotten Art o Tuition and Supplies: $ Forensic and Emergency Scene Photography 113 Hiring, Firing, and Retaining Volunteers 114 Night Time Auto 5:30 PM o Tuition: $ Aggressive Fire Attack with Limited Staffing 151 Critical Incident Stress Management 152 NIMS ICS A Pro Board Challenge - Firefighter 1 o Tuition, Testing, Certification, and Supplies: $ B Pro Board Challenge Firefighter 2 o March 4 o Tuition, Testing, Certification, and Supplies: $ Public Information Officer Basic o Textbook: $ Rapid Intervention Team (RIT) Operations o Tuition & Facility Fee: $ Rope Rescue Level Tactical Emergency Casualty Care (TECC) 158 Vehicle and Machinery Extrication Level Wildland Firefighter (S-130 / S-190), 3, 4 (2 nd begins at 6:00 PM)

4 Weekend Two Courses 200 Basement and Attic Fires o Tuition $ Hazardous Materials Awareness 202 Helicopter Fires 203 Swift Water Rescue Awareness 204 Working with K-9 Search and Rescue Teams 210 Commanding the Flood Response 211 Difficult Patient Packaging Scenarios 212 Emergency Response to Alternative Fueled Vehicles 213 Flashover Recognition and Survival o Tuition and Supplies: $ Night Time Wilderness Search and 5:30 PM o Tuition: $ Aggressive Search Tactics o Tuition & Facility Fee: $ Emergency Incident Rehabilitation 252 EVOC Emergency Vehicle Operations 253 Incident Safety Officer 254 Intensive Firefighter Safety and Survival

5 255 NIMS ICS Politics and The White Helmet 257 Rope Rescue Level UTV / ATV Safety and Rescue, 10, 11 (9 th begins at 6:00 PM) o Tuition: $ Vehicle and Machinery Extrication Level 2

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