Emergicare Medical Training Application
(Print form and mail into register for classes)
Individual
enrollment in all Backcountry Trail Patrol Association/Emergicare Medical
Training, Inc. (Emergicare) courses is limited. To reserve a space in an Emergicare
course, please return your application form and the appropriate tuition/deposit
to Emergicare. Courses under $200.00 require tuition payment in full
at the time of registration. Full, non-refundable and non-transferable tuition,
is due 14 days prior to the course. However, in the event of a student being
unable to attend a course they have registered for, their payment may be
applied to another Emergicare course at the same level, upon approval by
Emergicare Medical Training. Prior to 14 days before the course date, tuition
may be refunded, minus a 15% administrative fee.
If a program is cancelled by Emergicare due to low enrollment, the full deposit/tuition will be refunded.
REGISTRATION
INFORMATION
Name: ___________________________________________________
Email: ___________________________________________________
Address: __________________________________________________
City:
Phone: ____________________ Permanent Phone: ________________
Course Dates:______________ Course Location:_________________
Will you be 18 when the course starts? Yes ____ No ____ (Students under 18 must have parent/guardian consent)
Are you recertifying certification? Yes ____ No ____ (If "yes" please bring a copy of the certification card to the course)
Course recertifying: WFA ____ WAFA ____ WFR ____ WEMT ____ Certification from:_____________
PAYMENT
AMOUNT: (See below) ___________________
I the undersigned understand and agree that all course deposits are non-refundable and non-transferable under all circumstances, except as noted above.
Signature:_________________________________________________________
COURSE
INFORMATION AND COSTS:
Basic
Wilderness First Aid (includes textbook) $130.00
Basic and Advanced Wilderness First Aid
(includes textbooks and CPR certification) $200.00
Advanced WFA
with previous Basic WFA $130.00 (Certification must be through AAOS/ECSI or
equivalent provider within the past 24 months. Subtract $30.00 if you have the
current textbook.)
Wilderness
First Aid Refresher-Classroom sessions only (Field sessions optional.) with
current textbook.
$50.00 per session. (Basic WFA Weekend session 1,
Advanced WFA Weekend session 2)
Basic &
Advanced WFA and Wilderness
First Responder (AWFA to WFR “bridge”- includes textbooks and CPR) $350.00-Not offered at this time.
Wilderness
First Responder with previous AWFA certification (includes textbook) $175.00- Not offered at this time.
WFR
Refresher $100.00-Not offered at this time.
Single
Rescuer CPR $40.00
Make all checks payable to “Emergicare Medical Training" and mail to:
Emergicare Medical
Training Inc.
c/o Backcountry Trail Patrol Association,
Inc.