instructors: robert rodriguez hook & ladder party company ...€¦ · robert rodriguez hook...

Please list any special needs/Allergies : ________________________________________________________________________________ Last Name:____________________________________________________First Name:______________________________________ Address:___________________________________________________________________________________________________ Home Phone:____________________________ Cell Phone:___________________________ Grade:_____________________________ Email: _____________________________________________________________Payment: _________________________________ The undersigned agrees that the Village of Port Jefferson, it’s agents, officers, elected and appointed officials and employees shall not be liable for any claims, injuries, damages or expenses sustained by the undersigned as a result of participation in the activity described above. This release from liability shall apply to all such claims, injuries, damages or expenses regardless of who is at fault and even if caused by the negligence, neglect or fault of the Village of Port Jefferson, its agents, officers, elected and appointed officials and employees. This release is made with knowledge that the Village of Port Jefferson provides no insurance to cover claims, damages or expenses which may result from the described activity. SIGNATURE___________________________________________________________ DATE______________ Session 1: Monday, July 8 - Thursday, July 11, 2019 Session 2: Monday, August 19 - Thursday, August 22, 2019 Time: 5 - 6:30pm Fee: $100 per child Location: The Village Center, 101A East Broadway, Port Jefferson LIMITED SPACE (631) 802-2160 REGISTER BY PHONE › • We educate children in a full hands-on program that allows children to get a real perspective of what it means to be a firefighter. • We provide a fun & developmentally appropriate learning experience for all children. • We inspire teamwork, perseverance and promote a positive attitude towards solving problems. Instructors: Robert Rodriguez HOOK & LADDER PARTY COMPANY Port Jefferson Village Based BOYS & GIRLS GRADES 2 - 6 JR FIREFIGHTER CAMP Our educational programs for schools, camps and libraries begin with us arriving in a full scale fire engine. Over the course of the week children will engage in activities such as a fire safety presentation and how to use tools on the trade and many other activities that teach teamwork skills. The children will use those skills to compete in our firefighter obstacle course challenge. They will also have the opportunity to try our state of the art firefighter simulator. Each child receives a #FIREFIGHTER tee shirt!

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Page 1: Instructors: Robert Rodriguez HOOK & LADDER PARTY COMPANY ...€¦ · Robert Rodriguez HOOK & LADDER PARTY COMPANY Port Jefferson Village Based BOYS & GIRLS GRADES 2 - 6 JR FIREFIGHTER

Please list any special needs/Allergies : ________________________________________________________________________________

Last Name:____________________________________________________First Name:______________________________________

Address:___________________________________________________________________________________________________

Home Phone:____________________________ Cell Phone:___________________________ Grade:_____________________________

Email: _____________________________________________________________Payment: _________________________________The undersigned agrees that the Village of Port Jefferson, it’s agents, officers, elected and appointed officials and employees shall not be liable for any claims, injuries, damages or expenses sustained by the undersigned as a result of participation in the activity described above. This release from liability shall apply to all such claims, injuries, damages or expenses regardless of who is at fault and even if caused by the negligence, neglect or fault of the Village of Port Jefferson, its agents, officers, elected and appointed officials and employees. This release is made with knowledge that the Village of Port Jefferson provides no insurance to cover claims, damages or expenses which may result from the described activity.

SIGNATURE___________________________________________________________ DATE______________

Session 1: Monday, July 8 - Thursday, July 11, 2019Session 2: Monday, August 19 - Thursday, August 22, 2019

Time: 5 - 6:30pmFee: $100 per childLocation: The Village Center, 101A East Broadway, Port Jefferson

LIMITED SPACE (631) 802-2160REGISTER BY PHONE ›

• We educate children in a full hands-on

program that allows children to

get a real perspective of what it means to be a firefighter.

• We provide a fun & developmentally appropriate learning experience fo

r all children.

• We inspire teamwork, perseverance and promote a positive attit

ude towards

solving problems.

Instructors:Robert Rodriguez

HOOK & LADDERPARTY COMPANYPort Jefferson Village Based BOYS & GIRLS GRADES 2 - 6

JR FIREFIGHTER CAMP

Our educational programs for schools, camps and libraries begin with us arriving in a full scale fire engine. Over the course of the week children will engage in activities such as a fire safety presentation and how to use tools on the trade and many other activities that teach teamwork skills. The children will use those skills to compete in our firefighter obstacle course challenge.

They will also have the opportunity to try our state of the art firefighter simulator.

Each child

receives a

#FIREFIGHTER

tee shirt!

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