Fire/EMS Student Rider Application

Students must be enrolled in an eligible Fire/EMS program with one of the following continuing educational institutions. Choose one program.

Which program are you currently enrolled in?

The following lines will be rules and regulations to ride at PTFD. You cannot submit the form unless all boxes are checked. By checking the box below, you understand and agree to abide by all PTFD rules and regulations. I also understand that participation in the rider program is a privilege and any infraction of said rules and regulations may result in dismissal and exclusion from the rider program.

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

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

I do hereby release the Plain Township Fire Department 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.

The division EMS coordinator shall schedule all riders. The Battalion Chief on duty during the ride time shall assign riders to an apparatus.

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.

Riders shall be scheduled between the hours of 0800 and 2200. Requests for ride time after 2200 hours shall be reviewed by the Fire Chief. No riders are permitted between the hours of 2200 and 0800 without the express, written permission of the Fire Chief.

Riders may use the kitchen, restrooms, apparatus bays and training facilities of the fire station. 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.

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.

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.

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.