Training Order Form - Via Heart Project

Trading Order Form

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Ordered by/Billed To:

Company*

Ordered by/bill to Address*

Ordered by/bill to City*

Ordered by/bill to State*

Ordered by/bill to ZIP*

Ordered by/bill to Phone*

Ordered by/bill to Email*

Ordered by/bill to Contact Name*

Choose Your Class:

The AHA’s Heartsaver courses are designed for anyone with little or no medical training who needs first aid and/or CPR training and a course completion card for job, regulatory (i.e. OSHA), or other requirements. Heartsaver courses can also be taken by anyone who wants to be prepared to act in an emergency.

CPR/AED Class with certification:
Students Learn The Skills Necessary To Overcome Reluctance To Act In Emergency Situations And To Recognize And Care For Life-Threatening Respiratory Or Cardiac Emergencies
Through Hands-On Training And Video Demonstrations, Participants Will Learn How To Administer Effective CPR And Understand When And How To Use An Automated External Defibrillator (AED).

Class length is 2 hours. Instructors come to your site with all supplies and manikins. Class size is for up to 10 people. Certification for 2 years.

FIRST AID Class with certification:
Teaches Participants Critical Skills Needed To Respond To And Manage First Aid, Choking, Or Sudden Cardiac Arrest Emergencies In The First Few Minutes Until Emergency Medical Services (EMS) Arrives. Students Learn How to Treat Bleeding, Sprains, Broken Bones, Shock, And Other First Aid Emergencies.

Class length is 2 hours. Instructors come to your site with all supplies. Class size is for up to 10 people. Certification for 2 years.

CPR/AED/FIRST AID Class with certification:
Teaches Participants Critical Skills Needed To Respond To And Manage First Aid, Choking, Or Sudden Cardiac Arrest Emergencies In The First Few Minutes Until Emergency Medical Services (EMS) Arrives. Students Learn How To Treat Bleeding, Sprains, Broken Bones, Shock, And Other First Aid Emergencies.
Course Also Covers Adult CPR and AED Use.

Class length is 3.5-4 hours. Instructors come to your site with all supplies and manikins. Class size is for up to 10 people. Certification for 2 years.

Certification cards will be emailed within 21 days of course completion.

CPR/AED Certified Class ($800)

Please select the number of classes (NOT number of participants)

First Aid Certified Class ($800)

Please select the number of classes (NOT number of participants)

CPR/AED/First Aid Class ($1,200)

Please select the number of classes (NOT number of participants)

Training Location Details: and on-site contact person for the day of the training

Company*

Day of Training On-Site Contact Name*

Day of Training On-Site Contact Phone*

Training Site Address (If class will be virtual, please type VIRTUAL below)*

Day of Training On-Site Contact Email*

Training Site City*

Training Site State*

Training Site ZIP*

Preferred Training Date. Please provide 3 tentative dates and start time for your training day, 3 - 6 weeks from today.*

Covid-related protocols: What COVID-related protocols do you have in place that our Instructors will have to comply with (i.e. temperature check, health questionnaire, wearing of mask, etc.)*

Training Venue - Room Setup Requirements
General guide only – we cater to small and large venues Please advise us in advance if your venue does not meet the requirements below so we can assist you: - Adequate floor space to accommodate all participants (for CPR and recovery position plus scenarios) - Suitable heating or cooling depending on whether conditions for your staff comfort - Training area is carpeted or you have mats or towels available for everyone to kneel/lie on - Space for a projector screen (white whiteboard/wall) at the front of the class (with small table for laptop and projector) - Contact person should be at the venue 45 mins prior to the start time to let the Instructor in and to assist with setting up - Arrange parking close to training room to assist with unloading of equipment (or staff to assist) Training space be set up when possible in a U-Shape (chairs only).

Does your venue meet the requirements listed above?*

Yes

Will the contact person, or staff, arrive 45-60 minutes prior to the start time to let the trainer in and assist with setting up equipment?*

Yes

Is parking available at the training venue? **

Yes

If yes, please provide instructions.

If no, please provide information about nearby off site parking. Free street parking? Meters? Paid Parking?

Do you have a projector and/or a place to project available for use on the day of the training?*

Yes

Cancellation or Rescheduling: We must be notified at least 5 business days prior to the course date if there is a need for your company to cancel or reschedule, otherwise a $500 fee is applicable per session (per trainer scheduled). Life Support Solutions reserves the right to cancel a booking for any unforeseen circumstances and will reschedule the training on a suitable date (no refund or discounts will be provided if we are required to reschedule a booking).*

I have read and agree to the terms described above.

Invoices: Invoices will be emailed to the contact person listed on this booking form. They will be sent from Via Heart Project.*

I have read and agree to the billing terms described above.

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