Option 3: Travel Observation Request

Disclaimer: This is a request, and is not necessarily guaranteed. Will be accepted or denied based upon staff availability. 

Personal Information

Please complete the information below as the Primary Contact for travel observation. 

Note, this person is included as one of the possible ten instructors being recertified.

Name*
Mailing Address*

Observation Class Information

Please complete the information below regarding the class you (and/or staff) will be observed teaching.

Date/Time of Class Being Observed*
:  
Address of Class Being Observed*

Additional Instructor 1

Please fill out the following for each additional instructor being observed

Name
Mailing Address

Additional Instructor 2

Please fill out the following for each additional instructor being observed

Name
Mailing Address

Additional Instructor 3

Please fill out the following for each additional instructor being observed

Name
Mailing Address

Additional Instructor 4

Please fill out the following for each additional instructor being observed

Name
Mailing Address

Additional Instructor 5

Please fill out the following for each additional instructor being observed

Name
Mailing Address

Additional Instructor 6

Please fill out the following for each additional instructor being observed

Name
Mailing Address

Additional Instructor 7

Please fill out the following for each additional instructor being observed

Name
Mailing Address

Additional Instructor 8

Please fill out the following for each additional instructor being observed

Name
Mailing Address

Additional Instructor 9

Please fill out the following for each additional instructor being observed

Name
Mailing Address

Important Information

Note: Maximum number of instructors being recertified in one observation is ten instructors. 


Pricing: 

  • Base Price- $100.00
  • Fee Per Instructor- $30.00
  • Travel Fee- $1.50 per mile


Instructor(s) will be billed after class observation takes place. Recertification will be withheld until payment is made to CPR Safeā„¢

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