Out of District – Babysitting Training Registration

DHFD Hold Harmless Agreement 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. I understand and agree with the Hold Harmless Agreement.

Classes must be pre-paid at time of registration. PAYMENT IS NON- REFUNDABLE. 24-hour advance notice of any cancellation is required. Failure to do so, means you will not be allowed to enroll in future classes. If you cancel, you may reschedule ONE time. A second cancellation voids your agreement. Classes start at specified times, persons arriving late risk not being admitted to class.

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 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.

Download the EXHIBIT C – Income Self-Certification -and BRING IT WITH YOU - Community Development Block Grant is a federal funding program to support lower income households. This agency requires all program participants to give us information on income and family size in order to qualify for services. You must complete this self-certification stating that the information you provide is true to the best of your knowledge. All information will be confidential and no information will be released without your written consent. “I certify that all information provided on this application is true to the best of my knowledge. I also understand that I will provide verification of income if requested and that my income information may be subject to random sampling for statistical reporting purposes.”