SCAN | SCAN Training Registration

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SCAN Training Registration

All training registrations are due 10 days prior to the session. Priority is given by submission date.

Non-SCAN agency staff will be charged:

CPR: $15
CPI: $50
CPI Re-Cert: $25
Carseat: $25

Agencies will be invoiced after training is completed. If no agency is listed on the registration the individual will be invoiced. If a registrant No Shows more than once the agency will be charged for the seat. Payment is due within 30 days of the invoice date.

Personal Information

Name:

Cell #:

Email:

Date Hired:

Department:

Agency Information

Agency Name:

Agency City:

Immediate Supervisor:

Program Administrator:

Emergency Contact Information

Name:

Cell #:

Home #:

Training Information

This section will *NOT* work without JavaScript enabled. If you cannot enable JavaScript (see above instructions), you will need to contact SCAN directly to register at (260) 421-5000.

Training Type:

Note: If a training type is not listed, there are none offered at this time.

Selection:

Note: Locations marked TBA are based on # registered per area. Training may be offered in Fort Wayne, South Bend, Warsaw, or Merrillville.

Special Needs:

Additional Comments: