Welding AWS Certification Registration

Transcription

1 1105 North 19 th Street Phone (765) Elwood, IN Fax: (765) Welding AWS Certification Registration Application Date: Legal Name: Last First Middle Address: City: Zip: Gender: M F Age: Birthdate: (Mo-Day-Year) / / Minimum requirement: Must be at least 14 years of age and have entered high school. This is a non-credit bearing class. Telephone: Cell: Emergency Contact: Telephone: Class Dates: January 20 th April 23 rd 2015 Days: Tuesday & Thursday 5:30-9:00 p.m. No class will be held on: March 24 th, 26 th, 31 st, or April 2 nd *A session may be cancelled if there are not enough students enrolled. If so, students enrolled in that session will have the choice of receiving a full refund or transferring to an open session. Registration is on a first come basis by date of completed registration requirements. This class needs 10 students to be viable. Cost: $650 per class Personal checks will be accepted up until 2 weeks before classes begin. After that, the only acceptable forms of payment are: cash, money order, business check, or agency voucher. Additional Requirements: 1. Long pants/long sleeved, non-flammable clothing (at least 60% cotton) with no fraying. Fraying catches on fire quickly. Acceptable examples are cotton jeans and sweatshirt or Carhartt coveralls. 2. Clothing must not have any flammable liquids, such as gas or oil on them. 3. Leather or faux leather boots, mid to high top. Steel toed boots recommended. 4. Safety glasses. If you do not have a pair, the teacher will have them available for $5 per pair. 5. Minimum age requirement: Must be at least 14 years of age and have entered high school. This is a non-credit bearing class. 6. Welding jackets and welding masks are recommended. Gloves, jackets, and masks will be available for use at no charge. However, they can be purchased at a reduced rate through the program if you would like your own. Items available include: gloves, jackets, mask (basic), mask (electrical recommended). As the applicant, I understand that safety is a top priority and I will conduct myself appropriately to create a safe environment. Learning can only take place if in attendance and I understand attendance is a requirement. Missing classes will result in the forfeit of the class fee. Cancellations may be made up until the first night of the class for a full refund. No refunds will be issued after the first scheduled class. Student Date School Copy Notice of Nondiscrimination The School Board declares it to be the policy of the Elwood Community School Corporation to provide an equal opportunity to all students, regardless of race, color, creed, age, disability, religion, gender, ancestry, national origin, place of residence within the sending school district, or social or economic background, to learn through the curriculum offered in this Corporation.

2 1105 North 19 th Street Phone (765) Elwood, IN Fax: (765) Welding Lab Registration Information Date: Student Name Class Dates: Days: January 20 th April 23 rd 2015 (see calendar for breaks) Tuesday & Thursday evenings: 5:30-9:00 p.m. *A session may be cancelled if there are not enough students enrolled. If so, students enrolled in that session will have the choice of receiving a full refund or transferring to an open session. Registration is on a first come basis by date of completed registration requirements. Cost: $650 per class Personal checks will be accepted up until 2 weeks before classes begin. After that, the only acceptable forms of payment are: cash, money order, business check, or agency voucher. No refunds will be issued after the first scheduled class. Additional Requirements: 1. Long pants/long sleeved, non-flammable clothing (at least 60% cotton) with no fraying. Fraying catches on fire quickly. Acceptable examples are cotton jeans and sweatshirt or Carhartt coveralls. 2. Clothing must not have any flammable liquids, such as gas or oil on them. 3. Leather or faux leather boots, mid to high top. Steel toed boots recommended. 4. Safety glasses. If you do not have a pair, the teacher will have them available for $5 per pair. 5. Minimum age requirement: Must be at least 14 years of age and have entered high school. This is a noncredit bearing class. 6. Welding jackets and welding masks are recommended. Gloves, jackets, and masks will be available for use at no charge. However, they can be purchased at a reduced rate through the program if you would like your own. Items available include: gloves, jackets, mask (basic), mask (electrical recommended). Student Copy

3 Optional Item Fee Schedule: Recommended* Items available through Hinds Cost Amount Size/strength X Kromer cap (under helm) 8 X Tilman sweat band (under helm) 3 X Prostar Auto Darkening Helmet 120 Prostar Basic Helmet--Shade MAG Lens 2X (needed if reading glasses are worn) X Tilmand Blue Welding Jacket #S-XL 38 S M L XL Tilmand Blue Welding Jacket #XXL-XXXL XXL XXXL Prostar Full Leather Welding Jacket 68 S M L XL X Blue Heavy Welding Gloves -- MIG cert. 13 X Prostar Tig Gloves -- TIG cert. 10 X Jackson Nemesis Clear Safety Glasses (reg or over glasses) 5 Reg Over TOTAL *These are items that are helpful in class and will be needed by professional welders. Some equipment is available for use in class, or you can bring in equipment that you already own.

4 Hinds Career Center 1105 North 19th Street Elwood, IN James A. Pearson, Director Phone: (765) Fax: (765) LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT Please read carefully before signing. I,, hereby affirm that I am aware that welding has inherent risks which may result in Participant Name serious injury or death. I understand that welding involves certain inherent risks; burns to the skin and/or eyes, electrical shock, strained/torn muscles (from lifting materials), injury to fingers, arms, legs, feet, torso, eyes, neck and/or head. I further understand that instruction in welding processes may involve lifting materials, supplies, and/or equipment weighing up to 75 pounds in the course of instruction and laboratory activities. I understand and agree that neither my instructor, Malcolm Stalcup, the facility through which I receive my instruction, Hinds Career Center, 1105 North 19 th Street, Elwood, IN, nor Elwood Community School Corporation., nor any of their respective employees, officers, agents, contractors or assigns, (hereinafter referred to as Released Parties ) may be held liable or responsible in any way for any injury, death, or other damages to me, my family, estate, heirs or assigns that may occur as a result of my participation in this welding course or as a result of the negligence of any party, including the Released Parties, whether passive or active. In consideration of being allowed to participate in this course, I hereby personally assume all risks of participation in this course, whether foreseen or unforeseen, that may befall me while I am a participant in this course, including but not limited to the academics and laboratory/application activities. I further release, exempt and hold harmless said program and Released Parties from any claim or lawsuit by me, my family, estate, heirs, or assigns, arising out of my enrollment and participation in this course including both claims arising during the course or after I receive my certification, if I do so. I also understand that welding is a physically strenuous activity and that I will be exerting myself during this course, and that if I am injured as a result of a heart attack, panic, stroke, physical weakness, instability of balance, fall, or any other cause, that I expressly assume the risk of said injuries and that I will not hold the Released Parties responsible for the same. I understand the terms herein are contractual and not a mere recital, and that I have signed this document of my own free act and with the knowledge that I hereby agree to waive my legal rights. I further agree if any provision of this Agreement is found to be unenforceable or invalid, that provision shall be severed from this Agreement. The remainder of this Agreement will then be construed as though the unenforceable provision had never been contained herein. Serving: Alexandria Elwood Frankton Hamilton Heights Madison Grant Tipton Tri-Central

5 I,, BY THIS INSTRUMENT AGREE TO EXEMPT AND RELEASE MY Participant Name INSTRUCTOR, MALCOLM STALCUP, THE FACILITY THROUGH WHICH I RECEIVE MY INSTRUCTION, HINDS CARER CENTER, 1105 NORTH 19 th TREET, ELWOOD, IN, AND ELWOOD COMMUNITY SCHOOL CORPORATION, AND ALL RELATED ENTITIES AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH HOWEVER CAUSED, INCLUDING, BUT NOT LIMITED TO, THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE. I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT BY READING IT BEFORE I SIGNED IT ON BEHALF OF MYSELF AND MY HEIRS. I FURTHER STATE THAT I AM OF LAWFUL AGE AND LEGALLY COMPETENT TO SIGN THIS LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT. Participant s Signature Date (Day/Month/Year) (Rev. 02/14)

6 Welding Spring Hinds Career Center - January SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

7 Welding Spring Hinds Career Center - February SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

8 Welding Spring Hinds Career Center - March SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

9 Welding Spring Hinds Career Center - April SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY Review Session 5:30 7pm