RescueTechs Student Registration Form RescueTechs Student Registration FormPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.First Name *Middle Initial / Name *Last Name *Date of Birth *Department / Agency Affiliation: *PhoneEmail *EmailConfirm EmailAddress *City *County *State *Zip Code *Program you are registering for: *Farm Machinery Rescue - Union County West End - 7/22/2023Grain Bin Rescue Operations - Miles Township FC - 8/19/2023Grain Bin Rescue Awareness - Avis Fire Company - 8/27/2023Silo Fire & Emergency Awareness - Neffs FC - 9/18/2023Grain Bin Rescue Operations - Fannett-Metal VFC - 9/22/2023Grain Bin Rescue Operations - Bradford County DES - 9/29/2023Winching, Moving & Lifting - West Earl Fire Company - 10/7/2023Winching, Moving & Lifting - Hereford Fire Company - 10/14/2023Farm HazMat Training - Seneca County, NY - 10/14/2023Vehicle Rescue Training - Bird-in-Hand - 10/16/2023Heavy Vehicle Extrication - Bridgeville, DE - 11/3/2023Farm Emergency & Tractor/Machinery - Cheswold, DE - 11/17/2023By initialing below, I certify that I am a bona-fide member of my agency/department and is covered by workman’s compensation and liability coverage by this agency. RescueTechs LLC, the program instructors, and the host agency (if other than my own) assume no liability for injuries or deaths that occur as part of this training program. Please initial in the text field below to acknowledge.Student Initials *Submit