Student Involvement Program (SIP)

Glenwood Springs Fire Department

Student Involvement Program (SIP)

About the Program

The Glenwood Springs Fire Department (GSFD) is taking applications for The Student Involvement Program (SIP). Three Glenwood Springs area high school students will be selected to participate in the program. Sippers who attend all assigned shifts and complete all assignments will receive a Certificate of Completion and receive 5 high school credits. During the program, students will learn basic firefighting and EMS skills and theories while they experience daily life as a firefighter and accompany firefighters on emergency calls as an observer.

The Application Process

Eligible applicants must be a current high school junior or senior with reliable transportation to and from any fire station in Glenwood Springs. This application includes: personal information, teacher sponsor, GPA report, essay assignments, signature, parental consent with notarized (third rider form). A current semester GPA of 3.0 or greater is required.

Applications will be reviewed by The SIP Coordinator and Fire Officers. Top applicants will be interviewed by a GSFD panel for final selection. Selected SIP participants (Sippers) will attend an informational meeting accompanied by their parent or guardian. The one-hour informational session will outline time commitments, uniforms, learning activities, tasks, and experiences that the Sipper can expect. The informational meeting will also cover safety procedures, emergency vehicle operations, and biohazard risk reduction. Thereafter, Sippers will attend pre-assigned shifts where they will explore the profession of a firefighter/EMT with a mentor.

Participant Expectations, Time Commitment, and Cost

Sippers will be expected to follow the rules and guidelines of the program at all times. The majority of communication will be through email. Students are required to have a reliable email address and check it daily. Three assignments must be completed throughout The SIP including journal entries, a final paper, and a final project (see attached for additional details on the assignments). Sipper will attend 3 shifts a month during the program. Each shift will be a pre-assigned four-hour block.

Sippers may help prepare and eat a meal with their shift. The cost for the Sipper’s share of the meal will be five dollars per shift. Sippers will receive protective gloves, eye protection, hearing protection, uniform T-shirt, and safety vest prior to shift.

Contact SIP Coordinator , Paramedic Travis Rohe, for additional information at .

Glenwood Springs Fire Department

Student Involvement Program Application

Please type in the fields or print using black ink.

1) Name ______Phone Number ______

Address ______Birth Date ______

Email Address ______

2) I have my parent’s permission to apply for the GSFD Student Involvement Pilot Program (SIPP)?

Yes No

3)Parent/Guardian Name ______Phone Number ______

Address ______

Parent email______

Emergency Contacts (2 Required)

4) Name ______Phone Number ______

Name ______Phone Number ______

Medical Information

5) Medical Conditions ______

Allergies ______

Do you need any special accommodations to participate in the SIP due to medical status or disability?

Yes No

If yes, please explain______

Essay Questions

On a separate sheet of paper, provide answers to all of the following questions. Answers should be typed, grammatically correct, and free of errors. Answers to each question should be 300 words or less and should be single spaced.

1) Tell us about you. (Hobbies, interests, goals etc.)

2) Describe why you are interested in the Glenwood Springs Fire Department Student Involvement Program.

3) Without looking to outside sources, describe how you think The Glenwood Springs Fire Department serves the community and describe a firefighter’s daily routine.

4) How will this experience prepare you for life after high school?

______

Applicant Signature and Date

Teacher Sponsorship

Provide the signature of a teacher sponsor.

I think ______(applicant’s name) would benefit from the GSFD Student Involvement Program, would be a strong applicant, and take the experience seriously.

______

High School Teacher Sponsor Signature Date

______

Teacher Sponsor contact email

Proof of GPA

Provide proof of a current high school grade point average of 3.0 or higher and attach to this application.

Parental Consent

My child, ______, has my permission to participate in the Glenwood Springs Student Involvement Program. I give my consent to allow______to be a participant in the activities outlined in the program and do not hold The Glenwood Springs Fire Department, it’s individual members, or The City of Glenwood Springs responsible for damages, injuries, or death associated with the participation in this educational experience. I understand that while my son/daughter participates in this program they may be subject to stressful or hazardous environments including but not limited to: hydraulic tool, sharp tool, and power tool (chainsaw) readiness checks, use of tools utilizing compressed air, climbing on vehicles at a height of greater than 10 feet without safety straps, the practice of using self contained breathing devices and firefighting protecting gear, observing the emergency medical care and aftermath of the sick and injured including the possibility of seeing violence, gore, blood, bodily fluids, and nudity, riding in vehicles while responding emergent (lights and sirens) to emergencies, possible exposure to structure/vehicle/wildland fire, heat, and smoke conditions from a distance deemed safe by GSFD staff, possible exposure to hazardous materials including biohazard, exposure to motor vehicle traffic, hiking to remote areas during a rescue, exposure to environmental heat and cold.

I also understand that I will need to attend a mandatory information meeting prior to my child’s participation in SIP with an additional waiver and Contact of Understanding to be signed upon the meeting’s commencement.

______

Applicant Signature and Date Parent/Guardian Signature and Date

Additional forms include completed GSFD Third Rider Form

GLENWOOD SPRINGS FIRE DEPARTMENT

OBSERVER

RELEASE OF LIABILITY

I, ______, do hereby release the City of Glenwood Springs and all its officers and employees including members of the Glenwood Springs Fire Department from, and waive any and all liability, claims, demands for damages of whatsoever nature, including without limitation, claims arising from bodily injury, personal injury, property loss or damage, while riding as an Observer in a Glenwood Springs Fire Department emergency unit, or any liability as a result thereof during the date and hours approved herein by the Chief of the Glenwood Springs Fire Department.

Parent / Guardian (if under 18 years of age) Date

______

Observer Date Approved by Fire Chief: Date Observer Signature

SIP Program Authorized to Ride

This form must be notarized below

The foregoing was subscribed and sworn to before me this ______day of

______by______.

Observer (or Parent / Guardian if under 18 years of age)

Witness my hand and official seal.

My Commission expires: ______

______

Notary Public

Glenwood Springs Fire Department

Student Involvement Program

Contract of Understanding

To be signed after informational meeting

My son/daughter and I have read and understand all guidelines and have attended the informational/ safety meeting for GSFD SIP participation. We understand that Sippers serve as educational observers of The Glenwood Springs Fire Department emergency activities and are expected to participate in housekeeping and equipment check activities as allowed. The purpose is to learn the basics of firefighting and EMS to foster interest in future participation in emergency services and serving the community. We understand that Sippers are to follow all instructions from members of the GSFD and that the general standard of conduct is to act in a professional manner. We understand that he/she is expected to be courteous and respectful of other members and to all citizens as they are representing The Glenwood Springs Fire Department. Further, it is at the GSFDs sole discretion to dismiss a participant of SIPP. We understand that by signing this Contract of Understanding we are declaring that any violation of the guidelines, as determined in the sole discretion of GSFD personnel, is grounds for immediate dismissal.

______

SIPP Participant Signature and Date Parent/Guardian Signature and Date

Acknowledge Receipt of Rules and Guidelines

I acknowledge that my son/daughter and I have received a copy of the Glenwood Springs Student Involvement Program rules and guidelines and have reviewed them prior to signing these documents.

______

SIP Participant Signature and Date Parent/Guardian Signature and Date

GSFD Use only:

o Applicant and Guardian have provided:

o Application including personal info, emergency contact info, typed essay answers, teacher sponsorship, and GPA report, parental release.

o Signed 3rd Party Observer Release Liability Form and notary signature

o Signed CIRSA Liability Form

o Oral interview Panel

o Attended informational meeting

o Signed Consent of Understanding

______

SIPP Coordinator Signature and Date Fire Chief Signature and Date

RELEASE/INDEMNIFICATION – CITY OF GLENWOOD SPRINGS

GFSD/SIP

I. RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT: PARTICIPANT MUST READ CAREFULLY BEFORE SIGNING

In consideration for being permitted to participate in GFSD/SIPP, I hereby acknowledge, represent, and agree as follows:

A. I understand that the above-described activities are or may be dangerous and do or may involve risks of injury, loss, or damage, as described further in the SIPP application and Parental Consent forms. I further acknowledge that such risks may include but not be limited to bodily injury, personal injury, sickness, disease, death, and property loss or damage. I acknowledge that such risks may arise from a variety of foreseeable and unforeseeable circumstances connected with the GFSD/SIPP.

______(Participant initials here)