Request for Quote

1
CONTACT INFORMATION
2
What's your first name?* This field is required.
3
And your last name?* This field is required.
4
How about your email address:* This field is required.No spam - I promise!
Your information is safe with us!
5
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!
6
Name of agency you're representing:
7
Zip Code:* This field is required.Where the training will take place
8
CLASS
9
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
First Aid only
Bloodborne Pathogens
10
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
11
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
12
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.
13
How many students need to get certified?* This field is required.
1
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
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
24+
14
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
15
SCHEDULING
16
Which class layout do you prefer?* This field is required.
Entirely onsite
Blended online with onsite skills verification
I'm not sure
17
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
18
What are you questions/concerns about the blended training?
Huge
Large
Normal
Small
Ok
Ok
19
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
20
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
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Early Morning
Mid-morning
Mid-day
Afternoon
Evening
Early Morning
Mid-morning
Mid-day
Afternoon
Evening
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
1 of 5
21
Let us know if you have a particular date in mind:
22
Additional comments or questions:
Huge
Large
Normal
Small
Ok
Ok
23
How did you hear about Hands Down CPR?* This field is required.
Web Search
Post-Card
From a friend
Facebook
Cal eProcure
Should be Empty: