Red Cross First Aid / CPR - Smith & Associates

Company Name *

Name *

First

Last

Phone *

Requested Training Start Date / Time *

Date

Time

Number of Employees *

Students will be emailed Student Portal Information to begin their online individual training once quote is approved.

Employee #1 Name

First

Last

Employee #2 Name

First

Last

Employee #3 Name

First

Last

Employee #4 Name

First

Last

Employee #5 Name

First

Last

Employee #6 Name

First

Last

Employee #7 Name

First

Last

Employee #8 Name

First

Last

Request Training In *

Training Address Location *

Address Line 1

Address Line 2

City

State

Zip Code

Trainer Check in Process/Procedure if Applicable

Are there any special requirements for facility entry? *

Do you have a Projector available for use? *

Do you have Projection Screen or Wall Space available for use? *

Do you have a Television with HDMI connection? *

Will there be WIFI connection available for use? *

WiFi Name and Password

Training Day Contact Person Name *

First

Last

Training Day Contact Person Phone *

Training Day Contact Person Email *

Job Number if Applicable

Request Quote? *

Cancellation Policy

Once your service request is confirmed our Cancellation Policy applies. To cancel a previously scheduled service, please contact us at 510-670-0809 or info@smith4safety.com with at least 72 hours' notice prior to your scheduled service. We will cancel your appointment as directed. At this time, you may also reschedule a service for a new date and time, based on availability with a two-week advance notice preferred. Incurred cost (one day service fee, lodging reservations, rental car, travel expenses, etc.) will apply if scheduled appointment is not canceled within 72 hours.

Signature Agreement to Cancellation Policy *

Clear Signature

Please prove your a human by answering the question below. *

What is the first letter of the alphabet?