Rocky Mountain CPR and First Aid

Florida Training Academy (An American Heart Association Training Site) 103 Century 21 Drive, Suite 102 Jacksonville, Florida 32216 Phone: 904-551-0918 Fax: 904-302-8055 www.FLtraining.com

INSTRUCTOR AGREEMENT FORM

This is an agreement between ______, designated as a Basic Life Support (BLS) Instructor and/or Heartsaver Instructor, and Florida Training Academy, a contracted training site with the American Heart Association (AHA). This agreement is valid from issue date of the AHA Instructor card through the renewal date. The Instructor will conduct all BLS courses to include: Instructor, Healthcare Provider, Heartsaver, Heartsaver AED, Heartsaver CPR in Schools, Heartsaver First Aid, Heartsaver First with CPR & AED, Heartsaver Pediatric First Aid, CPR for Family & Friends, and Family & Friends First Aid for Children, in accordance with standards and guidelines set forth by the AHA, using the following criteria:

CRITERIA . Follow ALL of the most current AHA guidelines. . Maintain a copy of all rosters for classes taught for a period of three (3) years prior to submitting rosters, course monitoring forms, and required skills testing checklists to Florida Training Academy within 30 days of the course date. . Conduct the class using the appropriate video/DVD with the practice while watch (PWW) format. . Provide students access to the appropriate AHA manual before, during, and after the class. . Issue appropriate documentation of completion/participation to each student within 30 days of the class date. . Ensure all training will be done in an appropriate facility with all of the necessary equipment present. . Maintain proper sanitary conditions on all supplies and equipment. . Formally acknowledge that all fees for BLS training do not represent revenue to the AHA.

PROBLEM SOLVING Incomplete paperwork and classes taught improperly may result in the following:  Verbal communication to discuss problems.  Written communication with possible suspension and/or warning of termination.  Possible termination of Instructor privileges with Florida Training Academy.

This agreement is a one-year agreement and will terminate on and no later than the date noted on this agreement. Florida Training Academy reserves the right to terminate this agreement at anytime if Training Site policies and/or AHA standards and guidelines are not met. Once Florida Training Academy receives your first Course Roster with appropriate paperwork, if you choose to transfer your records to another authorized AHA Training Center or Training Site, a $25.00 Transfer of Records Fee will apply.

As an Instructor, I will adhere to the above criteria. I understand and agree to follow all of the above criteria and non-compliance may result in termination of this agreement.

______Instructor signature Date TS Coordinator signature Date INSTRUCTOR INFORMATION

NAME______

MAILING ADDRESS______

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PHONE #1______

PHONE #2______

E-MAIL______

ORGANIZATION or BUSINESS YOU TEACH FOR:

______

YEAR YOU FIRST BECAME AN AHA INSTRUCTOR:

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