Class Registration Form

ARFF CLASS SELECTION

 

All Fields are Required

     
   
First Name  
   
Last Name  
   
Organization  
   
Work Address  
   
City  
   
State / Province  
   
ZIP / Post Code  
   
Country  
   
Work Phone  
   
Work E-mail  
   
Confirm work E-mail  
   
Personal Phone  
   
Emergency Contact Name  
   
Emergency Contact Phone  
   
Dept. Head/Chief Name  
   
Dept. Head/Chief Phone  
   
Dept. Head/Chief Email  
   
Medical Conditions  
   
Allergies  
   
Fire Fighting Experience
 
   
Airport Experience
 
   
 
Receive additional training class updates and schedules via email.
 
   
   
   
 

INDIVIDUAL RELEASE OF LIABILITY FOR ARFF TRAINING

   
 
 

In consideration of receiving aircraft rescue and firefighting training at the Blue Grass Airport Regional ARFF Training Center, Versailles Road, Lexington, Kentucky, hereby unconditionally release and forever discharge Blue Grass Airport and the Lexington-Fayette Urban County Airport Board, their officers, directors, agents, representatives, and employees (hereinafter ³Releasees²) from any and all claims, liabilities and causes of action which I might have against the Releasees as a result of any injury or damages I sustain while participating in the training, in traveling to or from the training site, or in any way resulting from the training either during or after my participation in it, including injuries or damages resulting from the ordinary negligence or gross negligence of Releasees, as well as any claims third parties may have in any way resulting from the negligence or intentional misconduct of it or its personnel in the course of the training. This Release does not apply, however, to intentional, willful or wanton conduct by the Releasees.


I agree that:


    1. I have been briefed about this training and I am familiar with the type of physical ability necessary to participate in this training, and to the best of my knowledge, my health and physical condition are excellent and I am capable of undertaking this training.

    2. I am fully aware this training necessarily involves certain inherent and hazardous risks, and I voluntarily assume all risks this training presents, and request that I be given an opportunity to participate in this training.

    3. I am fully aware that this Release does not constitute a waiver by the Blue Grass Airport, Lexington-Fayette Urban County Airport Board or the Lexington-Fayette Urban County Government of their defense of governmental immunity, or any other defense recognized by the statues and common law of this Commonwealth.

    4. I have read and fully understand the terms and conditions of this Release of Liability and further understand that the opportunity to participate in this aircraft rescue and firefighting training is afforded by the Blue Grass Airport based upon my signing this document and that if I refuse to sign this Release I cannot participate in this training. However, I also understand that my refusal to sign the Release and my failure to participate in the training will not result in any adverse action against me by my unit/department.

Check and Initial to indicate waiver acceptance.
 

SELECT AND COMPLETE ONE PAYMENT TYPE

 

Pay by Credit Card

Cardholder Name  
   
Card Number  
   
Expiration Date   Use MM-YYYY date format.
   
CVV  
   
Billing Address Line 1  
   
Billing Address Line 2  
   
City  
   
State  
   
ZIP  
 

Pay by Check

    If selecting this option, an invoice will be generated in your registration confirmation. Payment is required on or before the first day of class.  
 

SPD CODE

    If you were issued an SPD Code, enter it here.
 

REQUIRED EQUIPMENT

   

All participants are required for providing the following equipment. For those traveling by air, where equipment transport may be difficult, contact the training center staff to inquire if alternate arrangements are available.


Required Equipment:
•Bunker coat/pants
•Fire gloves
•Fire boots (leather or rubber)
•Fire helmet
•Nomex hood
•SCBA with one bottle (two preferred)
 
   
     

Enter case-sensitive security characters:



4000 Terminal Drive, Suite 206 • Lexington, KY 40510-9607