MONTOUR AREA FIRE DEPARTMENTS

^9th ANNUAL FIRE SAFETY

SUMMER DAY CAMP

August 8^th, 9^th, & 10^th 2018

Age group 6-10 (only): 9:00am – 11:00am

Age group 11-15 (only): 1:00pm – 3:00pm

Located at the Danville Middle School (on Route 11)

The Montour Area Fire Departments are again hosting a Safety Summer Day Camp for Kids. The Camp will consist of Local Fire Departments as well as other area Public Safety organizations. The Camp will teach basic functions of each service and discuss safety tips with fun and positive exercises to educate children about the Do’s and Don’ts in personal safety. Kids will get to learn Firefighter duties and be able to see firsthand the operation of the various tools and apparatus used in the fire service as well as participate in various safe firefighting activities. Parents are more than welcome to also attend! There are NO FEES OR COSTS TO ATTEND.

Please Register Ahead

(Campers pre-registered by July 31st will receive a free tee-shirt)

Contact:

Mahoning Township Fire Chief Leslie Young

Phone Number: (570) 271-1801- or (570) 760-6494

Email: bugs62@ptd.net

Student Camper Registration Form

Mail to or drop off form: East End Fire Co. c/o: Fire Camp

954 Bloom Rd.

Danville, Pa. 17821

Or email to bugs62@ptd.net

Camper’s Name ______________________________________

Camper’s age _______

Parent/Guardian_________________________________

Address_________________________________________

_________________________________________

Emergency Contact Phone Number(s)________________

_________________

T-shirt size: Youth S M L Adult S M L XL

Must be pre-registered by July 31^st to receive a t-shirt (t-shirts are for camp participants only)

Additional Information Optional

Are there any conditions/concerns with camper that the staff should be aware of? (Note: confidentiality will be observed as required)

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

**Please be sure participants wear appropriate attire, including closed- toe shoes (no flip flops or sandals please).**

PARTICIPANT WAIVER OF RESPONSIBILITY FORM

The Montour Area Fire Departments will observe ALL safety practices to protect the participant’s well being. However being that the campers will participate in various exercises related to the fire service, in accordance to Child Labor Law, we do need the Parent/Legal understanding and signature to a waiver of responsibility to the Summer Safety Camp. Any questions are welcome.

I, the undersigned, by participating in the 8^th Annual Summer Fire Safety Day Camp hosted by Montour Area Fire Departments understand and agree that such activity has certain inherent risks that possibly can and do result in injury.

I, the undersigned, agree to release The Danville, Washingtonville, Riverside, Mahoning, Liberty, and Valley Township’s Fire Departments, as well as the Danville Area School District, its’ elected officials, employees or volunteers from all claims resulting from any and all injuries sustained while participating in the 8^th Annual Summer Fire Safety Day Camp, except that arising out of the sole negligence of the Fire Department(s) or the Danville Area School District, its’ elected officials, employees or volunteers.

I, the undersigned, also agree to allow photographs from The Departments and or media promoting the Summer Safety Camp that may or may not include my Child.

As participants are minors, a parent or legal guardian must sign this form.

_____________________________________________________________________________

Name of Participant (PRINT)

_____________________________________________________________________________

Name of Parent/ Legal Guardian

_____________________________________________________________________________

Signature of Parent/Legal Guardian releasing Fire Departments/ Danville Area School District

_____________________________________________________________________________

Signature of Parent/Legal Guardian releasing Photography of Participant