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CURRENTLY ACCEPTING NEW AMERICAN HEART ASSOCIATION INSTRUCTORS & TRANSFERS

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CURRENTLY ACCEPTING NEW AMERICAN HEART ASSOCIATION INSTRUCTORS & TRANSFERS

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TRAINING SITE APPLICATION

Kentucky Health & Safety Training

Training Site Application

Interested in becoming an Official American Heart Association Training Site?
Please complete the following application & receive a response from the Training Center with 5-7 business days!

Please complete all required fields below:

Organizations Legal Name registered with Secretary of State (SOS):

Owner’s Legal Name registered with Secretary of State (SOS):

Business Address registered with Secretary of State (SOS):

Business Phone Number:

Business Email:

Describe type of Business:

Please check all the disciplines you will be instructing.

BLS Instructor BLS Provider BLS Renewal HeartCode BLS Heartsaver Instructor Heartsaver CPRAED First Aid Heartsaver CPR Heartsaver First Aid Heartsaver Pediatric Heartsaver Blended Learning Courses Bloodborne Pathogens HandsOnly CPR

Are you currently a Training Site at another Training Center?

No Yes - Please upload any Training Site agreement. With list of current TCFs & possible transferring Instructors from current Training Center

Upload

Are you currently a BLS Instructor?

No Yes , upload copy of Instructor certification

Upload

Do you currently a TCF?

No Yes - please upload certificate if available

Upload

How many participants did you instruct per year (BLS & Heartsaver)?

Do you currently issue eCards?

No Yes

Do you currently use Enrollware for course records management?

No Yes – Explain how you currently manage records

Explain

Do you currently use Directive Feedback Manikins?

No Yes - Please provide brand

Provide brand

Do you currently have a website?

No Yes - Please provide URL

Provide URL

Do you the My Courses Tool on AHA Instructor Network?

No Yes

How far in advance do you post your courses for participants to register for?

Days in Advance Weeks in Advance 1-3 Months in Advance 3-6 Months in Advance 6-12 Months in Advance

Do you host on-site courses at businesses?

No Yes

Do you host community courses?

No Yes

Where do you currently hold your courses?

How often do you instruct courses?

Daily Weekly Monthly Every other month Several times a year

Please explain current refund policy for a course?

Please explain current no-show policy for a course?

Please explain current cancellation policy for a course?

Do you currently accept Visa, Mastercard, American Express, Discover?

No Yes

Please locate, then copy & paste below the American Heart Association payment disclaimer below:

Do you currently use the American Heart Association Training Site Logo?

No Yes

Do you currently carry liability insurance?

No Yes - please attach proof of current insurance certificate

Attach certificate

REQUIREMENT: Training Sites are required to maintain Commercial Liability insurance with a limit equal to or greater than $1,000,000 and a deductible no greater than $1,000, regardless of disciplines applied, from a carrier rated A, VII, or better.

Check one please:

I was the Training Site Coordinator who completed this application I was NOT the Training Site Coordinator who completed this application

This application was completed by (PRINT):

Signature

Date

Phone number:

E-mail:

Application Terms & Conditions: By e-signing this application above I have provided Kentucky Health and Safety Training, LLC with truthful and accurate information to be consider as an authorized American Heart Association Training Site under the direction of Kentucky Health and Safety Training. In the event any information is falsified, this application and/or Training Site agreement will be terminated immediately.