To Educate...Facilitate...Motivate

and prepare our students to proudly serve the community and continuously uphold our

"Commitment to Excellence"

PLEASE READ THIS CAREFULLY

You are completing Step 2 of the application for the Coral Springs Regional Institute of Public Safety's Entrance Physical Ability Test (EPAT). Upon successful completion of the EPAT, you will be eligible to apply for the Firefighter I & II program.

Please carefully complete this application as incorrect information could potentially remove you from the program.

If you are a returning student, please enter the primary email you have on record. A different email will cause a duplicate record to be created and may delay or deny your application in being processed.

Please be sure to enter your legal name (no nicknames).

In the event of an emergency, who should we notify?

If you are under the age of 18, you must complete this section.

Because not all pre-requisites are due at the time of application (some are due after application but prior to the start of class), this list is not all inclusive. Please visit the Firefighter I & II course description for complete details.

Students must successfully complete the Entrance PAT at the Coral Springs Regional Institute of Public Safety. If you do not have a valid Entrance PAT, your application will not be accepted.

Students who are accepted into the Firefighter I & II program will receive instructions welcoming them to CSRIPS and the required course pre-work.

In consideration for my acceptance to a training, testing, and/or educational program at the City of Coral Springs, I agree to sign this Release and Waiver. Accordingly, I agree to unconditionally release, waive, and discharge the City of Coral Springs, its Commission members, employees, agents, and servants, all hereafter referred to as “releases,” from all claims and causes of action, that I, my personal representatives, assigns, heirs, and next of kin, may have for any loss, damage, or injury to person or property, whether caused by the negligence, or otherwise of the releases in connection with my participation in any training, testing, and/or educational program at the City of Coral Springs. In addition, I agree to indemnify completely, the releases against all claims, demands, made by or on behalf of me in relation to my participation in any training, testing, and/or educational program and all causes of actions arising out of my own actions or involvement with the City of Coral Springs.

The physical requirements for the training, testing, and/or education program that I want to participate in have been explained to me and I certify and warrant that I am in good health and physical condition and able to participate in all activities that may be required. I also understand that I may come into contact with hazards, including but not limited to, blood borne pathogens, fire, and hazardous chemicals that may cause great bodily injury or death. I fully realize and appreciate the foregoing risks and freely and voluntarily accept those risks. Additionally, I agree to adhere to the applicable rules and regulations of the City of Coral Springs.

In addition, I authorize the City of Coral Springs or its agent to conduct a required criminal background check. I understand and authorize the City of Coral Springs to disclose this information to any and all clinical sites I may be involved with during my education at the City of Coral Springs. I understand and agree that I may be denied entry into the program, or removed from the program, due to an unacceptable criminal background, as determined by the City of Coral Springs, in their sole discretion.

I HAVE CAREFULLY READ THE FOREGOING RELEASE AND WAIVER AND KNOW THE CONTENTS THEREOF AND HAVE SIGNED THIS RELEASE AND WAIVER AS MY OWN FREE ACT.

I expressly agree that this Release and Waiver is intended to be as broad and as inclusive as permitted by the laws of the State of Florida, and that if any portion thereof is held invalid, it is agreed that the balance shall notwithstanding, continue in full force and effect.

I hereby confer on the City of Coral Springs the absolute, irrevocable right and permission to use my image, and/or my child's image, in City media that includes but is not limited to print, digital or video format, for the purposes of public information, historical documentation, and/or promotion of City events and activities. I give my consent freely, with the understanding that no remuneration of compensation will be forthcoming.