HANDS ONLY
CPR REQUEST FORM

BUSINESS VIRTUAL PROGRAM

* Required Field
Name*
Phone*
Email Address*
Business/Affiliation*
# of Trainees*
# of Trainees at one time*
Preferred Training Date*
<October 2021>
SunMonTueWedThuFriSat
262728293012
3456789
10111213141516
17181920212223
24252627282930
31123456
Alternate Training Date
(if Preferred is unavailable)*
<October 2021>
SunMonTueWedThuFriSat
262728293012
3456789
10111213141516
17181920212223
24252627282930
31123456
Alternate Training Date 2
(if Alternate is unavailable)*
<October 2021>
SunMonTueWedThuFriSat
262728293012
3456789
10111213141516
17181920212223
24252627282930
31123456
Additional Notes / Requests*

By Submitting this Request you acknowledge to the following:

I understand I or my business is responsible for any damages to equipment and agree to pay any and all replacement costs.

I understand all equipment must be picked up and returned to KCFR Headquarters 1590 E. Seltice Way, Post Falls, Idaho 83854 with 2 business days or after pre approved scheduled dates.

I understand I or my business is responsible for sanitizing equipment with proper cleaning supplies.

I understand this is NOT a certification course and only covers the basics of CPR only.

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