Senior Safety Academy DREXEL HEIGHTS FIRE DISTRICT5950 S. Cardinal Ave, Tucson, AZ 85746 www.drexelfire.orgSENIOR SAFETY ACADEMY - APPLICATION***Program held at DHFD Prince Administration *** Registration Date: * How did you hear about this class?: Website Flyer PCOA Station Sign OtherOther Participant’s Name: * Participant’s Phone Number: * Address * City * State * ZIP * Email * Advise us of any special needs: * Requested Class * Senior Safety Academy The academy meets for two sessions and each session is four hours. To start the program off, participants learn about the services DHFD has been providing for over 55 years. In the other class you’ll learn fire safety techniques (including using a fire extinguisher), fall prevention with Matter of Balance, information and community programs available to seniors. The program will conclude with a graduation ceremony. Which sessions do you plan on attending? * Academy 1: Academy 1: January 12 & 19, 2023 (8 am - Noon) Academy 2: Academy 2: February 2 & 9, 2023 (8 am - Noon) DHFD Hold Harmless Agreement * I understand and agree with the Hold Harmless Agreement. 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. DHFD Image Release Form * I understand and agree with the Hold Harmless Agreement. 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. Printed Last Name * Printed First Name * Printed Middle Initial * Signature * Clear Date * DHFD Witness Date reCAPTCHA If you are human, leave this field blank. Submit
