ATV Safety Injury Course Registration Form
Presented by the ATV Safety Institute & DHR Health Level 1 Injury Prevention Division
PLEASE READ BEFORE CONTINUING:
In order to take the HANDS ON portion of the ATV Safety class, the ATV E-Course needs to be completed and upload for the participant. Go to the following link: https://cbt.svia.org/login/index.php Click on Create New Account, follow the prompt and complete the E-Course It is completely FREE. Once completed, upload your certification to the box below AND bring a copy with you on the day of the class. Once you are accepted into the course, you will receive an email from the instructor with your waivers that need to be signed before the beginning of the class. More instructions will be given in the email.
If you have any medical issues or conditions, please let the instructor know before the class.
Participant Details:
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Full Name
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First Name
Last Name
Address
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City
State / Province
Postal / Zip Code
Age
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Phone Number
*
E-mail
*
example@example.com
Emergency Contact
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Full Name
Contact Number
1
Have you ever taken a safety course before?
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Yes
No
How did you hear about us?
*
Please Select
News Outlet
Social Media
Retailer
Other
Please Specify
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Will you be bringing your own ATV?
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Yes
No
If Yes, what is the VIN or Year, Make, Model of the ATV
How many years of ATV experience do you have?
*
What do you hope to gain from this class?
*
Before submitting, make sure you also have following equipment in order to participate in the class. Your own ATV, ATV Helmet or approved Department of Transportation (DOT) helmet, eye protection, gloves, long pants, long sleeve shirt or jacket, and over the ankle boots.
If you any questions please feel free to email the instructor at c.bravo@dhr-rgv.com or call 956-362-6285. Thank you
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