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WFDTA Course Registration

WFDTA Course Registration

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    Must provide - Necessary for state certification
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    Please list department if you are currently affiliated. *This question is required even if it is self pay. 
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  • 12
    Please Select
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    • Alabama
    • Alaska
    • Arizona
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    • California
    • Colorado
    • Connecticut
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    • District of Columbia
    • Florida
    • Georgia
    • Hawaii
    • Idaho
    • Illinois
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    • Iowa
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    • Louisiana
    • Maine
    • Maryland
    • Massachusetts
    • Michigan
    • Minnesota
    • Mississippi
    • Missouri
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    • New Mexico
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    • North Carolina
    • North Dakota
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    • South Dakota
    • Tennessee
    • Texas
    • Utah
    • Vermont
    • Virginia
    • Washington
    • West Virginia
    • Wisconsin
    • Wyoming
    Please Select
    • Please Select
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curaçao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • United States
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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    Please list Fire Chief or his designee for point of contact
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  • 16
    If completed please mark and attach.
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  • 17
    Please provide date of completion for NIMS 100
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  • 18
    Please provide date of completion for NIMS 700
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  • 19
    Please provide copies of prerequisites if available. NIMS 100, NIMS 700, BWC/Insurance verification, Physical , proof of certification if taking transition. *PDF’s preferred
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  • 20
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  • 21

    Please scroll to review full document

    The Wellston Fire Department Training Academy (herein “ACADEMY”), in making available its or other selected facilities, training grounds, equipment, and its staff, and in its provision of an opportunity to learn on the part of its students and other invitees, makes no representation of and assumes no liability for the suitability or condition of its or other selected facilities, training grounds or equipment, or for the competency of its staff, or for the quality and content of its educational services.


    The ACADEMY assumes no liability for and shall be indemnified and held harmless for any claims, demands or suits of any nature, kind or description whatsoever, including, but not limited to claims for direct, indirect or consequential damages, acts of god, or any types costs and expenses, for or on account of any loss or damage to property owned or possessed by any student or other invitee or any injury to any student or invitee which may result from any cause, including but not limited to, the condition and operation of ACADEMY facilities, training grounds, and equipment, or the condition and operations of any other selected facilities, training grounds and equipment, and the acts or omissions of members of its staff or the acts or missions of other students or invitees.


    The members of the ACADEMY staff and the instructors who are independent contractors with the state, in their personal and representative capacity, assume no liability for and shall be indemnified and held harmless for any claims, demands or suits of any nature, kind or description whatsoever, including, but not limited to claims for direct, indirect or consequential damages, acts of god, or any types costs and expenses, for or on account of any loss or damage to property owned or possessed by any student or other invitee or any injury to any student or invitee which may result from any cause, including but not limited to, the condition and operation of ACADEMY facilities, training grounds, and equipment, or the condition and operation of any other selected facilities, training grounds and equipment, and the acts or omissions of members of its staff or the acts or omissions of other students or invitees.


    Student or invitee hereby authorizes the ACADEMY to seek emergency medical assistance on his or her behalf, as necessary, and agrees to pay for any and all medical expenses incurred on his or her behalf, Student or invitee shall indemnify and hold harmless the ACADEMY for any and all such emergency medical expenses and for any claims related to the aid rendered to the student or invitee by the Academy or its Staff during any such emergency situation.


    By signing this document, the student or invitee hereby voluntarily acknowledges that he or she understands and accepts the above terms as a condition of the student or invitee’s participation in any Academy sponsored event, training, class, use of any State property or equipment or other circumstance as described in paragraph one of this waiver and that any such participation in the aforementioned activities may involve difficult, strenuous and dangerous physical activities to be undertaken by the student or invitee and that the student or invitee expressly assumes all of the risks associated with such activities. The student or invitee further expressly agrees not to bring a suit for damages against the City of Wellston, its employees or any independent contractors based upon any of student or invitees liabilities they waived in this document. This document constitutes the complete agreement between the parties.
     

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  • 22
    By signing this form I acknowledge and accept the terms of the WFDTA student Waiver.
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