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Matthew W. Adair: AHA TC Affiliate Instructor Roster

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26 views

Matthew W. Adair: AHA TC Affiliate Instructor Roster

Uploaded by

M A
Copyright
© © All Rights Reserved
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
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AHA TC Affiliate Instructor Roster

*This Roster is used for An Instructor who is affiliated with


Faithful Guardian Train Center but is not an Employee of FGTC
Email: [email protected] Webisite: www.faithguardian.com

HEALTHCARE Courses HEARTSAVER Courses Friends & Family Courses Courses Information Number
Computer or Online Course ( check here ): ________ Manikins
Healthcare Provider X Adult General Public Courses
ACLS Child CPR in Schools Course Date: JAN 17,2020 Adult: 4
ACLS EP Infant AED Total Course Hours:
PALS AED Adult Start Time: 17:00 End Time: 21:00 Child: 4
Physician available for Heartsaver First Aid Child
ACLS / ACLS EP / PALS Enviromental Infant Total Participants Complete: 12 Infant: 3
Emergencies First Aid
Course Location: OMS OFFICE AED: 4

Name of Instructor(s) CTC Instructor Email Instructor Number Instructor Phone


( Print Information ) (Found on AHA Inst. Network) ( Best Contact Number )
Lead Instructor
1 Matthew W Adair FGTC [email protected] 4130169710 (770) 940-2902

2 FGTC

3 FGTC

4 FGTC

5 FGTC

6 FGTC

Mail Card to -Bill to: TCF / RF Contact Information ( send monitor form )
Only fill out if not same as Lead Instructor Only fill out if monitoring / mentorintg instrutors Manikins Decontaminated By:
Name: Name:
Address: Address: Matthew W. Adair
City, St Zip: Villa Rica Georgia 30180 City, St Zip: Instructor Signature
Phone# Phone#
w W. Adair

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