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Name *

First name, middle initial, last name

Birthday *

Enter your birthday mm/dd/yyyy.  For example 01/01/2000

Date *

Select a date from the calendar.  

Home street address *

Number and street

City and State *

Email address *

Re-enter email address *

Please re-enter your email address

Contact number *

List the most reliable number to contact you.

School or Organization affiliation *

If you are not affiliated with a school or organization just enter "none".

Supervisor or Lead instructor's name *

Supervisor or lead instructor's title and phone number *

Type of program in which you are enrolled *

For example EMT-P, EMT-B, FFI, FFII etc.

Driver's license number *

Certification type and number *

For example EMT-P #0000

Rider rules and regulations *

The following lines will be rules and regulations to ride at NFD.  You will receive a copy of the rules via email when they are completed.  By selecting "yes" you understand and agree to abide by all NFD rules and regulations.  I also understand that participation in the rider program is a privelage and any infraction of said rules and regulations may result in dismissal and exclusion from the rider program.

Uniform requirements *

When affiliated with another department, the uniform for that department may be worn.  Otherwise, dark-colored pants with a light-colored shirt and dark shoes shall be worn.  No jeans, t-shirts, tennis shoes or worn items shall be permitted.

Appearance *

Riders shall be well groomed.  Long hair shall be tied back.  Jewelry and makeup shall be kept to a minimum.

Liability release *

I do hereby release the City of Newark, Division of Fire/EMS and its agents from any and all responsibility for an accident, illness, injury or death that may occur while participating either directly or indirectly in the rider program.  I further understand that I am riding strictly as an observer and will not attempt to take part in any unauthorized activities.  By agreeing to this statement I further attest that I agree with its contents, am at least 18 years of age and have not been convicted of a felony or crime(s) involving moral turpitude.

Sign up and assignments *

The division training coordinator shall shedule all riders.  The platoon commander on duty during the ride time shall assign riders to an apparatus.

Priority *

Students enrolled at an affiliated institution requesting ride time shall receive preference.  All other ride time requests will be at the sole discretion of the Fire Chief

Hours *

Riders shall be scheduled between the hours of 0800 and 2300.  Requests for ride time after 2300 hours shall be reviewed by the Fire Chief.  No riders are permitted between the hours of 2300 and 0800 without the express, written permission of the Fire Chief.

Stations *

Riders may use kitchens, restrooms, apparatus bays and training facilities of the divisions' fire stations.  Other areas are private living areas and as such are off limits.  No one shall be permitted in these areas without the express permission of the senior officer on duty at that station.

Vehicle/Station checks *

Riders are expected to participate in the checking and cleaning of the vehicle to which they are assigned.  Riders are permitted to participate in the cleaning of the areas in which they are authorized.

Patient care *

Student learning will not be at the expense of patient care.  Students shall not interfere with patient care.  Any requests to participate in patient care shall be made to and reviewed/approved by the in-charge medic on a patient-by-patient basis.

Confidentiality *

The patient's right to privacy shall be respected.  Patient information shall be shared only with those who are directly involved in their care.  You will be accountable in safeguarding phone numbers, addresses, relative's names, physical medical records, social security numbers, business records, cell phone data, verbal information provided by or about the patient, any other information that if disclosed would constitute an unwarranted invasion or breach of privacy.

Imposition *

Remember that the station provides living quarters for the crews on duty.  Take care not to impose.  It is the divisions' intent to provide a worthwhile learning experience, however, when in doubt it is better to ask first.

Idle time *

Students are required to bring their course materials with them and are expected to study if not busy with calls for service.

Violations *

Any and all violations shall be reported to the students learning institution or home department.

Questions *

Any questions relating to patient care shall be directed to the medic in charge.  All other inquiries shall be directed to the officer in charge.