PLEASE READ THE FOLLOWING CAREFULLY:
DATE OF THE DRILL: Saturday, September 19, 2015
TIME TO REPORT: You may come in as early as 6:00 a.m., but be here by 7:00 a.m.
INSTRUCTIONS:
1. Wear OLD clothing, as the make-up that is used may stain and/or the clothing may be cut to simulate injuries. Do not bring any jewelry or valuables with you.
2. Park in the CLEVELAND HOPKINS INTERNATIONAL AIRPORT short term parking garage. You will be given a pass to park there when leaving the Fire Station. There will be a shuttle to bring you to the Fire Station.
3. Sign in carefully, giving your full and correct name, address, city, and zip code.
4. When you sign you will receive:
Q A grocery bag that is numbered in which to place any small personal items during the drill. The bags will be returned to you when you sign out.
Q Numbered tickets, which will be your number for your turn for make-up and drill participation.
5. Go to the Victim Waiting Area. Enjoy refreshments, books, and playing cards; watch TV, etc. until your number is called for you to be made up with injuries.
6. BE PATIENT AND CHEERFUL! It takes a long time to make up 200 or more victims and to ensure that they are ready to start the drill.
7. Please stay in your area and follow directions. Each activity has a reason, and if anyone varies from the plan, unnecessary delays occur. If you wander, you may not hear your number when it’s called, and you might have to wait longer than necessary.
Above all, enjoy your day with us! You are a critical component of the drill. Without victims, it couldn’t be done!
Thank you,
Roosevelt Davis Jr.
Chief
Cleveland Aircraft Rescue Fire Fighting
NAME:__________________________________________________________________
ADDRESS:_______________________________________________________________
CITY_________________________ STATE____________ ZIP CODE_______________
BIRTHDATE:_____________________________________________________________
PHONE/E-MAIL ___________________________________________________
(To notify you upon receipt of form)
In consideration of being permitted to participate in the September 19, 2015, Cleveland Hopkins International Airport mass casualty incident exercise, I hereby state that I am (1) 12 years or older; and (2) that I am of sound mental and physical health. I have listed any medical problems and/or allergies (if any) below that may be of consequence should any unforeseen problem arise during this disaster drill.
I also agree that while participating in this exercise, I accept full responsibility and forever release all participating agencies from any and all liability and/or responsibility.
MEDICAL PROBLEM (S):___________________________________________________
ALLERGIES:______________________________________________________________
Name, address and phone number of person to be notified in case of emergency:
NAME:__________________________________________________________________
ADDRESS:_______________________________________________________________
PHONE NUMBER:_________________________________________________________
RELATION TO YOU:_______________________________________________________
SIGNATURE:_________________________ DATE:______________________________
WITNESS:_______________________________________________________________
NOTE: Anyone under 18 years of age must have parental consent to participate.
Parent or Guardian Signature _______________________________________________
Please fax to 216-265-6785 or e-mail to dflower@clevelandairport.com
ALL FORMS MUST BE RECEIVED NO LATER THAN FRIDAY, SEPTEMBER 4, 2015.