Sissonville Fire & Rescue School Registration 2018 PERSONAL INFORMATION NAME AGENCY ADDRESS CITY STATE ZIP PERSONAL PHONE AGENCY PHONE BIRTHDATE / / T-SHIRT SIZE EMAIL ADDRESS 001 - Firefighter 1 002 - Firefighter 2 003 - Driver / Operator - Pumper WEEKEND ONE 100 - Grant Writing for Public Safety Agencies 101 - 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 111 - Forcible Entry: The Forgotten Art 112 - Forensic and Emergency Scene Photography 113 - Hiring, Firing, and Retaining Volunteers 114 - Night Time Auto Extrication 150 - Aggressive Fire Attack with Limited Staffing 151 - Critical Incident Stress Management (CISM) 152 - NIMS ICS 300 153-A - Pro Board Challenge - Firefighter 1 153-B - Pro Board Challenge - Firefighter 2 154 - Public Information Officer - Basic 155 - Rapid Intervention Team (RIT) Operations 156 - Rope Rescue Level 1 157 - Tactical Emergency Casualty Care (TECC) 158 - Vehicle and Machinery Extrication Level 1 159 - 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 004 - Fire Officer 1 & 2 005 - Hazardous Materials Technician 006 - Intro to Technical Rescue (Rescue Core) WEEKEND TWO 200 - Basement and Attic Fires 201 - 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 214 - Night Time Wilderness Search and Rescue 250 - Aggressive Search Tactics 251 - Emergency Incident Rehabilitation 252 - EVOC - Emergency Vehicle Operations Course 253 - Incident Safety Officer 254 - Intensive Firefighter Safety and Survival 255 - NIMS ICS 400 256 - Politics and The White Helmet 257 - Rope Rescue Level 2 258 - UTV / ATV Safety and Rescue 259 - 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 13096 Sissonville, WV 25360 HTTP://WWW.SISSONVILLEFIRESCHOOL.COM YOU WILL BE NOTIFIED VIA EMAIL 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: $
2018 Sissonville Fire & Rescue School Pricing Sheet Two-Weekend Courses 001 Firefighter 1 o Tuition, Textbook, Access Code, and Facility Fee: $375.00 002 Firefighter 2 o Textbook: $100.00 003 Driver / Operator Pumper o Textbook: $80.00 004 Fire Officer 1 & 2 o Textbook: $75.00 005 Hazardous Materials Technician o Textbook: $80.00 006 Intro to Technical Rescue (Rescue Core) Weekend One Courses 100 Grant Writing for Public Safety Agencies @ 8:00 AM o Tuition & Supplies: $45.00 101 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
111 Forcible Entry: The Forgotten Art o Tuition and Supplies: $60.00 112 Forensic and Emergency Scene Photography 113 Hiring, Firing, and Retaining Volunteers 114 Night Time Auto Extrication @ 5:30 PM o Tuition: $60.00 150 Aggressive Fire Attack with Limited Staffing 151 Critical Incident Stress Management 152 NIMS ICS 300 153-A Pro Board Challenge - Firefighter 1 o Tuition, Testing, Certification, and Supplies: $300.00 153-B Pro Board Challenge Firefighter 2 o March 4 o Tuition, Testing, Certification, and Supplies: $300.00 154 Public Information Officer Basic o Textbook: $25.00 155 Rapid Intervention Team (RIT) Operations o Tuition & Facility Fee: $150.00 156 Rope Rescue Level 1 157 Tactical Emergency Casualty Care (TECC) 158 Vehicle and Machinery Extrication Level 1 159 Wildland Firefighter (S-130 / S-190), 3, 4 (2 nd begins at 6:00 PM)
Weekend Two Courses 200 Basement and Attic Fires o Tuition $30.00 201 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: $60.00 214 Night Time Wilderness Search and Rescue @ 5:30 PM o Tuition: $60.00 250 Aggressive Search Tactics o Tuition & Facility Fee: $150.00 251 Emergency Incident Rehabilitation 252 EVOC Emergency Vehicle Operations 253 Incident Safety Officer 254 Intensive Firefighter Safety and Survival
255 NIMS ICS 400 256 Politics and The White Helmet 257 Rope Rescue Level 2 258 UTV / ATV Safety and Rescue, 10, 11 (9 th begins at 6:00 PM) o Tuition: $150.00 259 Vehicle and Machinery Extrication Level 2