Clearwater County - School Visit Request

School Visit Request

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	<fields>
		<field type="header" subtype="h2" label="Before submitting a request ensure you read our general guidelines and liability statement (linked on the previous page)." class="header"></field>
		<field type="checkbox-group" required="true" label="School Location" class="checkbox-group" name="checkbox-group-1678304694828">
			<option value="Caroline School (Grades K-12)" selected="true">Caroline School (Grades K-12)</option>
			<option value="Charlotte Small Elementary School, Condor">Charlotte Small Elementary School, Condor</option>
			<option value="David Thompson High School, Leslieville">David Thompson High School, Leslieville</option>
			<option value="Ecole Rocky Elementary (Grades K-5, English and French)">Ecole Rocky Elementary (Grades K-5, English and French)</option>
			<option value="Kootenay School Grades (6-9)">Kootenay School Grades (6-9)</option>
			<option value="Lochearn Elementary School (Grades K-5)">Lochearn Elementary School (Grades K-5)</option>
			<option value="Pioneer Middle School (Grades 6-8)">Pioneer Middle School (Grades 6-8)</option>
			<option value="Rocky Christian School (Grades K-9)">Rocky Christian School (Grades K-9)</option>
			<option value="Visions West Outreach School (Grades 10-12)">Visions West Outreach School (Grades 10-12)</option>
			<option value="West Central High School (Grades 9-12)">West Central High School (Grades 9-12)</option>
			<option value="St. Matthew Catholic School (Grades K-8)">St. Matthew Catholic School (Grades K-8)</option>
			<option value="St. Dominic Catholic High School (9-12)">St. Dominic Catholic High School (9-12)</option>
		</field>
		<field type="text" subtype="text" required="true" label="Requested Date for School Visit" class="form-control text-input" name="text-1678311130246"></field>
		<field type="text" subtype="text" required="true" label="Number and Age of Attendees:" class="form-control text-input" name="text-1678311167398"></field>
		<field type="text" subtype="text" required="true" label="Desired Learning Goal:" class="form-control text-input" name="text-1678311183733"></field>
		<field type="text" subtype="text" required="true" label="Additional Notes/Information:" class="form-control text-input" name="text-1678311205068"></field>
		<field type="text" subtype="text" required="true" label="Contact Name:" class="form-control text-input" name="text-1678311219006"></field>
		<field type="text" subtype="text" required="true" label="Contact Number:" class="form-control text-input" name="text-1678311230966"></field>
		<field type="text" subtype="text" required="true" label="Contact Email:" class="form-control text-input" name="text-1678311244533"></field>
		<field type="paragraph" subtype="p" label="GENERAL GUIDELINES - Tours and event participation are provided for Clearwater County, Rocky Mountain House and Village of Caroline organizations. - Public education requests, including fire station tours, require at least one-month advance notice. - Although time will be scheduled for the event/tour, crews may be called to respond to an emergency at any time. If a fire crew is called away and unable to complete the request, CRFRS will be happy to accommodate your group another day. - Ensure that vehicles are not parked in front of the fire station bay doors and park in the designated parking area located at the side of the hall or in front of the library (Rocky Station). - You are visiting an active fire station and will be briefed on a safe place to gather your group if the crews are called out on an emergency. - Groups should consist of no more than 25 people, including necessary chaperones. One adult for every four children below the age of 12. - During station tours, there are not facilities available for you to prepare or cook food/cake. - The request must align with CRFRS mission, vision and values.    " class="paragraph"></field>
		<field type="paragraph" subtype="p" label="LIABILITY, WAIVER OF CLAIMS &amp;amp; INDEMNITY AGREEMENT In consideration of being allowed to participate in the requested activity in partnership with Clearwater Regional Fire Rescue Services (CRFRS), you must agree to the following: 1. TO WAIVE any and all claims that I have or may in the future against Clearwater County, the Town of Rocky Mountain House, Village of Caroline and their officers, employees, agents, volunteers and representatives (all of whom are hereafter referred to as “the releasees”); related in any way to the activity. 2. TO RELEASE the releasees from any and all liability for any loss, damage, injury and expense I may suffer or that my next of kin or heirs may suffer, or those individuals in my care as a result of my involvement in the above-referred to activity and my presence with the County’s regional fire service or the scene of an emergency or Fire Department activity due to any cause whatsoever. 3. TO HOLD HARMLESS AND IDEMNIFY THE RELEASEES from any and all liability for any damage to property of, or persons injured to, any third party, resulting from participation on the above-captioned activity. 4. This agreement shall be effective and binding upon by heirs, next of kin, executors, administrators, assigns and representatives in the event of my death or incapacity. 5. I hereby grant Clearwater County permission to the use of my likeliness (or that of those attending the event) in a photograph, video, or other digital media in any and all its publications, including web-based publications, without payment or other considerations." class="paragraph"></field>
		<field type="checkbox" required="true" label="By clicking submit, you and your group have reviewed and agree to the above terms and conditions (the full document is available on the previous page). " class="checkbox" name="checkbox-1678311301030"></field>
	</fields>
</form-template>

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