DREXEL HEIGHTS FIRE DISTRICT
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SENIOR SAFETY ACADEMY APPLICATION
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Indicates required field
Participant's Name
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First
Last
Address
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Line 1
Line 2
City
State
Zip Code
Country
Phone Number
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Email
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Advise us of any special needs:
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How did you hear about this program?
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Website
Flyer
Fire Station Marquees
Pima Council on Aging
Desert Times Newspaper
Friend
Social Media
Morning Blend
Other
Select Which Session You Want To Attend:
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Session 1: January 7 & 14 (Tuesdays), 8:30am-noon
Hold Harmless
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As consideration for the opportunity to participate in the Academy, the Participant agrees to protect, hold harmless and indemnify the Drexel Heights Fire District, Pima Council on Aging, and Pima County, officers, agents, their employees and their volunteers, against all liabilities, claims, suits or demands for Injuries to person and/or property arising out of his/her participation in all of the events and activities of the Academy. Participant assumes all risks of injury.
Image Release Waiver
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I hereby grant permission to be photographed and/or videotaped while participating in Drexel Heights Fire District activities and/or to have any such work incorporating my image or original work I produce in conjunction with the activity published in association with Drexel Heights Fire District’s promotional and/or educational activities. I waive any right to compensation for such photographs, videotapes, images, and/or original work for the use or publication thereof.
Drexel Heights Fire District provides education and information to the community concerning fire and life safety issues. In providing these services, it is often beneficial to utilize actual photographs, video tapes, or work pertaining to emergency incidents, services, or programs. Completion of this form will allow Drexel Heights Fire District to utilize photographs, videos, and original work in either print materials, public service announcements, public presentations, public displays, or on the department’s website.
I agree to receiving marketing and promotional materials
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Submit
Home
About DHFD
Chief's Message
Administration
History
Employment
Annual Reports
Customer Survey
Contact Us
Boards
Governing Board Members
Governing Board Meetings
Pension Board
Requests
Classes & Programs
Babysittng Training
Bicycle Helmets
Booster Seats
CPR Training
Home Safety Checks
Senior Safety Academy
Volunteers
Operations
Stations
Training
Fire Prevention
Fire Code
Burn Permits
Lock Box
Fireworks
Links
National Weather Service