Student Enrollment Form (24 and 40hr HAZWOPER)

Select Course*

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Company, Agency, or Organization*

IMPORTANT: This class involves the use of restrictive personal protective equipment (PPE) such as chemical suits, air purifying respirators, and self-contained breathing apparatus. Wearing and using this type of equipment can be arduous and taxing on the body.

Accomodations can be made for students who have physical, psychological, or medical restrictions on the use of this type of PPE.

Are you medically cleared and physically able to wear restrictive PPE in a classroom or mock scenario setting?*

YesNo (classroom accommodations will be made)

REGISTRATION: This registration does not confirm your successful registration in the selected course. You will be contacted after submitting this form to complete registration.

PAYMENT DETAILS: You will be contacted via email when this course is confirmed. Payment is due prior to class start date or per organizational agreement.

CANCELLATION AND REFUND POLICY: This type of course has a small class size and significant costs associated with hosting. As such, there are restrictions on cancellations and refunds.

Students may cancel and receive a full refund up to 7 days before class start. Organizations may change students at no cost up to course start, so long as the same total number of students attend. Cancellations with less than 7 days notice and before class start will recieve a 50% refund. Cancellations after class start will recieve no refund.

If class is cancelled or rescheduled by Leading Edge, all students will recieve a full refund or credit for a future class.