Student Enrollment Form

Student Enrollment Form

Please contact Mark@heightsabovellc.com if you have any questions regarding the below information, and/or refer to our Privacy Policy.
What is the start date of the class you'll be joining?*

MonthDayYear
Date
Name*

First NameLast Name
Your Personal Email Address*
example@example.com
Your Personal Phone Number*
Please enter a valid phone number.
Work Email Address
example@example.com
Work Phone Number
Please enter a valid phone number.
Date of Birth

MonthDayYear
Date
Your Sponsoring Employer (If Applicable)
What Program would you like to enroll in?*

5-Day Comprehensive S.P.R.A.T. Level 15-Day Comprehensive S.P.R.A.T. Level 25-Day Comprehensive S.P.R.A.T. Level 33 Year S.P.R.A.T. RecertificationFall Protection Competent PersonRope Access FundamentalsFirst Aid CPR/Advanced First AidSPRAT Work-At-HeightAdvanced RescuePowered Personnel AscendersSuspended Scaffold Competent Person, Introduction to Rigging PrinciplesRope Access Program AdministratorAuthorized Fall Protection UserTree Climber Primer
Note: If you chose 5-Day Comprehensive S.P.R.A.T. Level 2, or 3-Year S.P.R.A.T. Recertification, please provide Hours Logbook via email to Mark@heightsabovellc.com.
Please provide your background in roped activities, e.g. years practiced, disciplines, equipment used, tasks performed, etc (if applicable)*
Prior S.P.R.A.T. Number (ID) If Applicable
Number of signed/verified hours logged through SPRAT
What are your end goals with this training opportunity?
Emergency Contact Information (Please Provide Two)*
Your Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address Invoices can be sent to

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please describe any physical restrictions/limitations that might limit abilities to safely perform rope access maneuvers, or to help other students aloft in mock-up rescue scenarios or write N/A if not applicable.
Please list any allergies (including latex/non-edible allergens) or write N/A if not applicable*
Please list any dietary restrictions*
Where did you hear about Heights Above LLC?*
Should be Empty: