Form Center

2. 
4. DUE TO COVID-19, WE ARE CLOSED TO THE PUBLIC UNTIL FURTHER NOTICE.
6. This form is REQUIRED and should be submitted at least 4-weeks in advance. Email requests to Training Staff to reserve space will no longer be accepted and verbal agreements to reserve facility will not be a guarantee that space has been reserved. We will no longer check availability prior to submitting form.
8. Please initial indicating that you have read and understand the statement above.*
10. First Name*
    Person submitting request
11. Last Name
13. Title*
14. Organization*
16. Address1*
18. Address2
20. City
21. State
22. Zip
24. Phone Number*
25. Email Address*
27. Class/Meeting Title*
28. Class/Meeting Size*
30. Date(s) Requested*
32. Start Time (Actual)*
    Start Time (Actual)
33. End Time (Actual)*
    End Time (Actual)
35. Instructor/Meeting Facilitator's Name*
36. Instructor/Meeting Facilitator's Phone Number*
40. Area(s) Requested: To ensure everyone has an opportunity to use all resources, we are no longer accepting broad reservations for multiple areas during the actual time frame requested. If an agency is requesting a classroom and an area outside, you must indicate the time frame each resource will be used on your training day.
42. Please initial indicating that you have read and understand the statement above.*
44. Classrooms: We do not have connectivity for meeting facilitators to use laptops and IT support will not be provided for this purpose. All presentations must be on a USB thumb drive.
46. Please initial indicating that you have read and understand the statement above.*
48. Choices*

    1. Classroom
    2. Burn Building (live burns)
    3. Burn Building (no burns)
    4. Cones
    5. Drafting Basin (Pond)
    6. Extrication Pad
    7. Flammable Gas Prop
    8. Forcible Entry Prop Building

    1. Grounds - Behind Annex
    2. Grounds - Burn Building
    3. Grounds - Main Roadway
    4. Grounds - Pull Up Bars/Rescue Hill Drive
    5. Grounds - Tower
    6. Maze Building
    7. Pole Building
    8. Tower Building
50. Indicate Time Frame for Each Resource Checked
54. (Choose all that apply)*

    1. Fire Evolutions/Live Burns
    2. Gas Evolutions
    3. Explosives
    4. Rope Rescue Evolutions (at heights > 15')

    1. Vehicle Extrication
    2. Simunitions
    3. No hazardous activity will be conducted.
56. If your class involves one of the hazardous activities above, a lesson plan must be attached.
58. Please initial indicating that you have read and understand the statement above. Type N/A if not applicable.*
60. Lesson Plan / Syllabus / Agenda
62. Additional Comments
66. IF YOU ARE NOT A FREDERICK COUNTY GOVERNMENT AGENCY, A CERTIFICATE OR PROOF OF INSURANCE AND COURSE OUTLINE MUST BE PROVIDED PRIOR TO USE OF ANY AREA IN WHICH PHYSICAL ACTIVITY MAY CAUSE INJURY.
    Certificates of Insurance may take up to 4-weeks to be approved by Risk Management.
68. Please initial indicating that you have read and understand the statement above. Type N/A if not applicable.*
70. Certificate of Insurance
72. Agencies are responsible for returning the area of use to it's original state.
74. Please initial indicating that you have read and understand the statement above.*
76. IF YOU NEED TO CANCEL, please notify Francis Malta ASAP via email: fmalta@frederickcountymd.gov
Leave This Blank:


78. 1. Receive an email copy of this form.
79. Email address

    This field is not part of the form submission.

80. Submit

* indicates a required field