Harvey County ESA

Basic Firemanship Day
Saturday, October 15, 2005

Sign Up Sheet

Check courses and circle time desired—Students may be reassigned times due to class size limitations.  We will limit class size to not more than 20 students for each session.  Students will need to bring PPE, SCBA and show fit testing before being allowed to participate.

                                                                                                                        Morning                          Afternoon

___ Interior Fire Attack (two hour session)                    0800  &   1000       1300  &  1500

___LP Burn Props (two hour session)                           0800  &   1000       1300  &  1500

___Hose Evolutions (two hour session)                         0800  &   1000       1300  &  1500

___Forcible & Ventilation (two hour session)                0800  &   1000       1300  &  1500

___SCBA Confidence  (two hour session)                    0800  &   1000       1300  &  1500

___Basic Pump Operations (circle 1 session)                0800-1200              1300-1700

___Basic Wildland Firefighting(circle 1 session)            0800-1200               1300-1700

Please Print:

Name:              _________________________________   DOB __________________

Address:           __________________________________

City, St, Zip:     __________________________________

Phone:              __________________________________

Department:      __________________________________

Dept. Address: __________________________________

Dept. City, St, Zip:________________________________

KU Fire Training is handling the registration for this training.  Send completed application to: