Private Group Class Request Form

**Private Group Classes are for 2 or more participants who wish to have private group session with an Madilin Training Academy. These classes are only offered in-class at MTA in downtown Valdosta, Ga** If you wish to schedule a private group class at your preferred site and are not a business, then you will need to request a Mobile Class here.

Requestor’s Name*

First NameLast Name

Requestor’s Email*

Confirmation Emailexample@example.com

Requestor’s Phone Number*

Please enter a valid phone number.

Group Work Setting Type*

Private Group Course Option & Fees (1-PARTICIPANT ONLY)*

BLS Provider (Blended Learning: online + skills) $65 per participantBLS Provider Renewal (Instructor Led) $60 per participantHeartsaver CPR/AED/First Aid (Blended Learning: online + skills) $95 per participantHeartsaver Pediatric CPR/AED/First Aid (Blended Learning: online +skills) $120 per participant

PRIVATE GROUP CLASSES OFFERED: (Make sure the class selected above is the same as selected below) *

BLS PROVIDER

$65.00 Number of Participants

BLS RENEWAL

$60.00 Number of Participants

HEARTSAVER CPR/AED/FIRST AID

$95.00 Number of Participants

HEARTSAVER PEDIATRIC CPR/AED/FIRST AID

$120.00 Number of Participants

URGENT CLASS REQUEST FEE (LESS THAN 24 HOURS NOTICEBEFORE paying this fee, call us at 229-207-3055 if you're needing a private class in the next 24 hours to ensure instructor availability. *Non-refundable*

$70.00

RUSH CLASS REQUEST FEE (36 HOURS NOTICE)BEFORE paying this fee, call us at 229-207-3055 if you're needing a private class in the next 36 hours to ensure instructor availability. *Non-refundable*

$50.00

Total

$0.00

List all participants name & email below, including the requestor if they’re attending:*

After submitting this form, you will receive a call from a MTA instructor to discuss your private group class needs, instructor availability. Once your phone screen with the instructor is complete, you will placed on the MTA calendar.

FOR URGENT OR RUSH CLASSES: Group private classes cancelled after class is scheduled with MTA Instructor will only receieve a 50% refund of fees paid for the course only to the original method of payment. No rush or urgent fees will be refunded, as last minute accommodations are made for rush and/or urgent requests.

FOR URGENT CLASS REQUESTS: Any participants who are no shows or cancels after the group class has been scheduled will forfeit all fees paid. NO EXCEPTIONS!

Other than noted above,MTA's standard cancellation and refund policy will prevail.

BLS PROVIDER CPR/AED (FOR HEALTHCARE)

Reflects science and education from the 2020 American Heart Association Guidelines Update for CPR and Emergency Cardiovascular Care (ECC)

American Heart Association HeartCode BLS is a blended learning course that combines eLearning (online course) followed by a hands-on skill session with an instructor.

Part 1 - A self-paced series of online training modules (Up to 2 hours)
Part 2 - Skills practice session at our facility (Up to 1 hour 10 minutes)

Description: Basic Life Support (BLS) that is aligned for person(s) involved in childcare who have a duty to respond to illnesses and injuries in a child or infant.

Duration: Up to 1 hour private in-class skills session + Up to 4 hours online

Certification: 2 year American Heart Association certificate

Required Online Course: Prior to the in-class skills session, you MUST complete the online Heartcode BLS course thru the AHA eLearning website for $32.50 (payable to the AHA when you sign up for the online course).

Schedule: This is a private class offered at MTAs Valdosta, Ga location by appointment only. A MTA instructor will call you to schedule your private class appointment.

BLS RENEWAL CPR/AED (FOR HEALTHCARE)

Reflects science and education from the 2020 American Heart Association Guidelines Update for CPR and Emergency Cardiovascular Care (ECC)

American Heart Association BLS Renewal is a an instructor led course for AHA BLS Providers needing to renew their BLS certification.

**PROOF OF VALID BLS PROVIDER CERTIFICATION**

If your certification is expired, you will need to enroll in the BLS Provider course.

Description: Basic Life Support (BLS) that is aligned for person(s) involved in childcare who have a duty to respond to illnesses and injuries in a child or infant.

Class Format: This course is Instructor-led classroom format. No online course required.

Certification: 2 year American Heart Association BLS Provider e-card

REQUIRED Manual: - Participants may bring their own BLS Provider Manual (2020 edition required by the AHA) or purchase an ebook online for $14.

Schedule: This is a private class offered at MTAs Valdosta, Ga location by appointment only. A MTA instructor will call you to schedule your private class appointment.

Heartsaver Pediatric First Aid/CPR/AED

Description: Heartsaver Pediatric First Aid CPR AED that is aligned for person(s) involved in childcare who have a duty to respond to illnesses and injuries in a child or infant.

Duration: Up to 1 hour private in-class skills session + Up to 4 hours online

Certification: 2 year American Heart Association certificate

Online Course: Prior to the skills check session, all participants must complete the online videos thru the AHA eLearning website. You will receive access information in your confirmation email.

Schedule: This is a private class offered at MTAs Valdosta, Ga location by appointment only. A MTA instructor will call you to schedule your private class appointment.

Heartsaver First Aid/CPR/AED

Description: The American Heart Association Heartsaver First Aid, CPR/AED certification class provides instruction to participants on how to first aid, CPR, and use an automated external defibrillator (AED) in a safe, timely, and effective manner.

Reflects science and education from the American Heart Association Guidelines Update for CPR and Emergency Cardiovascular Care (ECC).

Adult, Child and Infant CPR
How to use an Automated External Defibrillator (AED)
Conscious and Unconscious Choking
Basic First Aid including burns; cuts; head, neck and back injuries and more

Duration: Up to 1 hour private in-class skills session + Up to 4 hours online

Certification: 2 year American Heart Association certificate

Online Course: Prior to the skills check session, all participants must complete the online course thru the AHA eLearning website for $19.50.

Schedule: This is a private class offered at MTAs Valdosta, Ga location by appointment only. A MTA instructor will call you to schedule your private class appointment.

I understand that:*

I must call Madilin Training Academy to schedule my private group class after submitting this form.I have 30 days to schedule my private group class from the date of submitting this form or I will forfeit all fees paid.Private group classes are limited up to (9) participants only.That all private group classes are held at MTA downtown Valdosta, GA.If I am requesting a private group class with a 36 hours' notice or less than a 24 hours' notice, then I am subject to additional fees, as described above.