Request for Quote

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CONTACT INFORMATION
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What's your first name?
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And your last name?* This field is required.
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What's your name?* This field is required.
First Name
Last Name
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How about your email address:* This field is required.No spam - I promise!
Your information is safe with us!
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Phone number:* This field is required.Email is generally preferred when responding to a quote but sometimes a phone call is best. :)
Again - your information is safe with us!
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Name of agency you're representing:
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Zip Code:* This field is required.Where the training will take place
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CLASS
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Which class are you interested in?* This field is required.If unsure, make your best guess and let me know your questions in the comments section later in this request.
CPR, AED, & First Aid for Adults
CPR, AED, & First Aid for Infant, Children, & Adults
CPR & AED for Adults
CPR & AED for Infant, Children, & Adults
Bloodborne Pathogens
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CPR, AED, & First Aid for Infant, Children & Adults - great! Do you require an EMSA Sticker?* This field is required.CA EMSA Stickers apply to Licensed Child Care Providers, Bus Drivers, and other professions as required under Title 22 of California State Law.
Yes - I'm a child care worker
Yes - I'm a bus driver
No
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Since I require an EMSA Sticker, I understand that my class must include 4 hours of CPR and 4 hours of First Aid (8 hours total).* This field is required.The 8-hour class is required for both initial and re-certification classes.
Yes
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I would like our 8-hour class to be:* This field is required.
From 9:00 am - 5:30pm with a 30 minute lunch
Split up - 4 hours of First Aid one day, and 4 hours of CPR another day.
Not sure.
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How many students need to get certified?* This field is required.
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Choose a range or specific number
Not sure exactly, but less than 6
Not sure exactly, between 6-12
Not sure exactly, between 13-24
Not sure exactly, but more than 24
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Which population should your class be tailored to?* This field is required.Who are you most likely to apply your skills to? -- Choose as many as apply -- If you are unsure, select "General Population"
General Population
Mental Health
Intellectual Disabilities
Long-Term Care
Medically Fragile
Children
Elderly
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SCHEDULING
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Which class layout do you prefer?* This field is required.
Entirely onsite
Blended online with onsite skills verification
I'm not sure
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When completing a blended program, all students will need to fully complete the online portion before the onsite skills verification can take place.* This field is required.It is best to complete the online portion within 5-10 days so the information is fresh for the skills verification.
I understand.
I have some questions
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What are you questions/concerns about the blended training?
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What type of workbook and certification do you prefer?DIGITAL: The Digital Book can be downloaded as a pdf file to most devices | Certification is always available online; can be printed and saved to any device // PHYSICAL: Book and certification are physical | Copies of certification can be made. (+ $6/book) // Last minute classes may require the digital option depending on current stock
Digital
Physical
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Select your preferred training days and start times belowExample: Mark if the first box if you'd like to start the class on a Monday at 8am
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Let us know if you have a particular date in mind:
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Additional comments or questions:
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How did you hear about Hands Down CPR?* This field is required.
Web Search
Post-Card
From a friend
Facebook
Cal eProcure
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