GENESEE COUNTYASSOCIATION OF FIRE CHIEF’S
Genesee CountyTraining Committee
Elevator Training
Registration Form
RETURN BY February 19, 2018
SMOKE COURSE: 2018-2Z-25-K10B-0356
Elevator TrainingClass –City of Burton FD, 1320 S. Belsay Rd., Burton MI 48509
Saturday, February 24, 2018 - Starting at 0800
Class is limited to 50 students
Course Description: The intent of this course is to provide Fire Fighters with information on how elevators are constructed, and operate, how to use an elevator key to unlock entry door, who to contact in case of an elevator emergency, and safety tips.
This is free class. Each student will be registered in SMOKE by the Genesee County Training Committee Chairman since this a closed course being offered only to GCAFC member departments personnel. If the class registration doesn’t reach 15 by February 12, the class will be opened up to state registration.
Registration (Fill out completely and PRINT LEGIBLY)
Name:______Department: ______
SMOKE Personal ID #: ______NFIRS: ______
Home Address: ______
City, zip: ______Phone: ______
Date of Birth: ______Email:______
NOTE: To insure communication via email with the student is effective, please be sure the email listed matches the one listed in SMOKE.
Emergency Contact Person: ______Phone: ______
All class registration forms must be approved and signed by the Fire Chief. By the Chiefs signature, it is assumed the person named above is a current member of the fire department covered by all workers compensation and injury insurance deemed appropriate by the fire department being represented.
* THIS INFORMATION IS CONFIDENTIAL AND IS PROTECTED BY THE FEDERAL PRIVACY ACT.
______
Fire Chief Signature or typed name AND email account Contact Phone Number
Mail, email (NO FAX AVAILABLE) completed registration forms to: Brent Cole, Swartz Creek Area Fire Department, 1411 Houston Dr., Swartz Creek, MI 48473 Telephone: 810-691-2641 email:
D:\COLE\OFFT\Training Committee\Course Registrations\2018\Elevator Training\ElevatorTraining022418.docx