GROUP REQUEST FORM | GARCIA SERVICES, HEALTH AND EDUCATION

Does your business, college or group require CPR, AED, First Aid and/or Universal Precautions/ Bloodborne Pathogen Training?

Please fill up this request form. We will contact you shortly to discuss your training needs.

Please note that all training is conducted on Saturdays only.

GROUP/ CORPORATE REQUEST FORM

If you are a human and are seeing this field, please leave it blank.

Fields marked with an * are required

First Name *

Last Name *

Address 1 *

Address 2

City *

Zip / Post Code *

Email *

Phone *

Course Requested for HEALTHCARE PROVIDERS (Check ONLY One)

BLS CPR + AED (INITIAL) for Healthcare Providers ONLY

BLS CPR + AED (RENEWAL) for Healthcare Providers Only

Course Requested for NON- HEALTHCARE PROVIDERS (Check ONLY One)

COMMUNITY CPR + AED

COMMUNITY CPR + AED + First Aid

Select an OSHA Related Course (Healthcare and Non- Healthcare Providers)

Bloodborne Pathogen and Universal Precautions

How Many in the Group?

Provide Course At Your Site? Please Check One (Corporate, Collegiate, Or Group Setting ONLY)

Yes

If Training for Corporate, Collegiate or Group Setting, Requested At Your Site, Please Provide Your Site's Address Below.

Since we could only acccomodate this at your site during a Saturday, please provide us at least 3 possible dates that is convenient for you. Thank you.

Other Comments, Questions or Concers