Hosting Form For EquiFirst Aid East Coast

Hosting Form For Host Location Information
Host Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Best time and method to reach you*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Farm or Facility/Business Name   First Name*   Last Name*
*Please note that we cannot set up classes without the farm/facility/business owner's name, contact info, and permission to have the clinic.
If you are filling out this form as a host, but are not the owner of the farm/facility/business please list their info so they can be contacted
**If you lease and carry insurance for the property, you are considered "owner" for the sake of our contract and do not need to list a name here.
Owners name:   First Name   Last Name   Email
Area Code   Phone Number
Website Address of Farm/Facility/Business:*
Please copy and paste your URL here
Facebook Page/Instragram and other social media links - (If you do not have social media, please provide an explanation of how we will get attendees for the classes outside of our company marketing efforts. For example, boarders, neighbors, local clubs, 4H groups, etc) *
Please list individually or write Closed Group if you have a built in audience that wants to take the class.
Check out our Course Descriptions on our Website and choose which courses you want to host below.

Equine Courses

Safety, Disaster Planning, Emergency Management, and First Responder
I would like to Host the following classes (choose all that apply) Classes with an (*asterisk) have the option to run as a hybrid class with classroom portion being done via the Instructor's Zoom and the hands-on being done at the host location*

*Equine Health and Emergency First Aid (Basic) - 7-8 hours*Advanced Equine Health and Emergency First Aid (Advanced) - 6-8 hours*Advanced Wilderness (Advanced) - 6-8 hoursBack Country Remote First Aid - 3 -4 hoursEquine First Aid Fundamentals - 3 - 4 hours*Disaster Planning and Emergency Preparedness - 6-8 hours*Safe Trailering - 5-7 hours*Livestock Handling for First Responders - 6-7 hours*Essentials in Emergency Preparedness - 2 hours (Online via Zoom or on site)
1st Potential Hosting Date - *Unless you have a built in audience or social network to organize a class and get paid registrants, most classes take 3-6 months to fill up. Please keep this in mind when picking your date. Dates are not promised until registration interest is gauged - please feel free to list a few date options and start times. Full day classes are 7-8 hours and should pick 9 or 10 AM for start time. Half day classes are 3-4 hours and can pick 9 AM, 10 AM, 1 PM, 2 PM for a start time. *
2nd Potential Hosting Date - *Unless you have a built in audience or social network to organize a class and get paid registrants, most classes take 3-6 months to fill up. Please keep this in mind when picking your date. Dates are not promised until registration interest is gauged - please feel free to list a few date options and start times. Full day classes are 7-8 hours and should pick 9 or 10 AM for start time. Half day classes are 3-4 hours and can pick 9 AM, 10 AM, 1 PM, 2 PM for a start time. *
3rd Potential Hosting Date - *Unless you have a built in audience or social network to organize a class and get paid registrants, most classes take 3-6 months to fill up. Please keep this in mind when picking your date. Dates are not promised until registration interest is gauged - please feel free to list a few date options and start times. Full day classes are 7-8 hours and should pick 9 or 10 AM for start time. Half day classes are 3-4 hours and can pick 9 AM, 10 AM, 1 PM, 2 PM for a start time. *
Comments/Special Accomodations (Optional)
Where did you hear about us and the classes?*

Facebook Page - EquiFirst Aid East CoastFacebook GroupWebsite - EquiFirst Aid East CoastWebsite - OtherHost LocationOther
Please sign here that you have examined both the Hosting Agreement and the Release of Liability. By signing you agree with both documents and will abide by the terms and conditions stated in both documents*

Powered by Jotform SignClear
Please verify that you are human*
Should be Empty:

Hosting Form For Host Location Information