Firefighter Cadet Program

Participant Application

Last Name:
First Name:
Address:
Email Address:
City:
State:	Zip:
Home Phone:
Cell Phone:
Father’s Name:
Mother’s Name:
Date of Birth:
Social Security #:
Driver’s License #:
School:
Counselor:
What are your expectations from being a cadet?
All applicants must be at least 16 years old. All information on this application must be accurate. The La Salle Fire Department reserves the right to accept or reject any application for the Cadet Program.
Signature:
Date:
Parent/Guardian Signature:
Date:

Firefighter Cadet Program

Emergency Contact Information

Last Name:
First Name:
Address:
Email Address:
City:
State:	Zip:
Home Phone:
Cell Phone:
Date of Birth:
In case of an emergency, whom should we contact?
Name	Relationship	Phone Number
Do you have any Medical Conditions?
Cardiac/Heart:
Allergies:

Asthma/Respiratory:
Stroke:
Diabetes:
Vision/Hearing:
Other:
Certain activities throughout the Cadet Program may involve a moderate degree physical exertion. It is advised that participants with any of the conditions above check with their physician prior to participating in the Cadet Program. Participation is purely voluntary and shall not be considered a requisite for acceptance.

Firefighter Cadet Program

Release and Indemnification

I have voluntarily applied to join the La Salle Fire Department’s Cadet Program. As part of this application, I agree and understand that the use of any and all equipment, tools, apparatus, or participation in any Department activities shall be at my own risk.

Based on my understanding and acceptance of the risks involved in participating in the Cadet Program, and in consideration of accepting my application to participate in activities of the Cadet Program, I waive and release any claims that I may have as a result of my participation in the program activities. The La Salle Fire Department, City of LaSalle, its officers, members, and employees shall not be liable to me or to my property arising out of my participation in the Cadet Program. I understand that as a participant in the Cadet Program I may encounter firefighter and emergency medical training at the Fire Department, as well as at the scene of a fire or emergency call. I further understand that as a participant in the Cadet Program, I may be allowed to ride along with trained firefighters and paramedics in emergency vehicles, and that participating in such activities may be dangerous at times.

I/We, as parent(s) of the undersigned, agree and acknowledge that there are risks associated with firefighting activities and being in and around a fire station. In spite of these risks, I/we authorize my/our child to be involved in the Cadet Program, and accept the fact that there may be risks involved. I/We further hereby indemnify and hold harmless the La Salle Fire Department, officers, members, employees, and agents from and against any and all injuries, claims, liabilities, cause of action, damages, and adverse actions arising as a result of my child’s actions or omissions, or the actions or omissions of a third party, and whether arising on behalf of my child or on the behalf of any third party, except to the extent that such injuries, claims, liabilities, cause of action, damages, or adverse actions are the direct result of any authorized actions or omissions of any officer, employee, member, or other agent of the La Salle Fire Department undertaken in ordinary course of employment or business of the La Salle Fire Department.
Applicant Signature:
Printed Name:
Parent/Guardian Signature:
Printed Name:
Witness Signature:
Printed Name:
Signed this	day of	,	.
Day #
Month
Year

Firefighter Cadet Program

Cadet Training Sheet

Topic	Instructor Name
Orientation
Protective Clothing & SCBA
Fire Hose and Water Supply
Extinguishers
Ladders
Fire Streams
Ventilation
Fire Behavior
Building Construction
Forcible Entry
Rescue & Extrication
Ropes
Loss Control
Fire Control
Alarms and Communications
Origin and Cause
Prevention and Public Education
Cadet Name:
Date Complete:
Instructor Signature:

Dale Tieman

2014-05-16

Kara Garten

Hewlett-Packard Company