Sponsoring Organization
*
Troop 1158, Sierra Club, Dynarex Corp., etc.
Contact Name
*
First Name
Last Name
Title/Position
*
Program Director, etc.
E-mail
*
Confirmation Email
Phone Number
*
-
Area Code
Phone Number
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Course & Date Information
Choose your course, course dates and more...
Desired Course
*
Please Select
CHOOSE YOUR COURSE
+ Wilderness First Aid
+ Wilderness First Aid (Hybrid) In-Person Session
+ Wilderness First Aid Afloat
+ Wilderness Advanced First Aid
+ Wilderness First Responder
+ Wilderness First Responder (Hybrid) In-Person Session
+ Wilderness EMT Upgrade
+ Alpine First Responder (Hybrid) In-Person Session
- Adult + Pediatric CPR/AED
- CPR/AED TRAINING (not certification)
- Infant + Child CPR/AED
- Standard First Aid
- CPR/AED + First Aid Combo
- EpiPen + Asthma Inhaler Training
> BSA First Aid Merit Badge
> Stop The Bleed (Bleeding Control)
> CUSTOM COURSE
Stop The Bleed (Bleeding Control) and Boy Scout Merit Badge classes are currently ONLY available in the greater Northern Virginia/Maryland/DC area.
Start Date (1st Choice)
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
Year
Start Date (2nd Choice)
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
Year
Start Date (3rd Choice)
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
Year
Timeframe
Morning
Afternoon
Evening
All-Day
NOTICE: This field does NOT pertain to **WILDERNESS MEDICINE** courses.
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Course Location + Logistics
Host organizations are responsible for providing the course location.
Course Location Reserved?
*
Please Select
We don't know yet
We have several options in mind
We have a location already booked
Location
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Course Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Location Amenities
*
AC/Heat
Tables
Chairs
Electricity
Projector
Projector Screen
Restrooms
Indoor Space (for indoor skills practice)
Kitchen
Wilderness/Outdoor Area (for outdoor skills practice)
Parking
Internet (ethernet or wireless)
Outdoor pavilion
OVERNIGHT: Indoor sleeping accommodations
OVERNIGHT: Tenting or Outdoor sleeping accommodations
Additional Amenities
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Enrollment Options
Let's get a feel for who this course is for...
Anticipated # of Students
*
Please Select
8 – 12 Participants
12 – 15 Participants
15 – 18 Participants
18 – 21 Participants
21 – 30 Participants
30 – 50 Participants
>50 Participants
The minimum to host a course is typically 8 to 12 students.
Who can Enroll for this Course?
*
Please Select
PUBLIC – Anyone can register for this course
SCOUTING – Scouts + Scout Leaders can also register for this course
PRIVATE – ONLY our members can register for this course
Public courses may help subsidize your course.
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