DT4EMS Instructor Course Registration Form

Course Dates: August 4th - 8th, 2010

E.V.E.-4-EMS/Fire (Instructor Course)

Location: Faithful Guardian Training Center (770) 214- 2252 ask for Niki
220 West Wilson St.
Villa Rica, Georgia 30180
Contact: E-Mail: Jay Gazaway or Kip Teitsort @ 417-699-4877 for more information

Full Name:______Date:______
Home Address:______State:______Zip:______
Home Phone: ______email: ______
Agency Name:______Work Phone:______
Agency Address:______State:______Zip:______
I agree to abide by the safety rules and regulations set forth by DT4EMS, LLC and agree to hold harmless DT4EMS, LLC and it’s Instructors, agents and associates for any injury arising from my participation in any training hosted by DT4EMS, LLC. I also understand that I am not an employee of DT4EMS LLC and I am not allowed to teach any of the material taught by DT4EMS, LLC independently (all courses must be approved by DT4EMS, LLC). I understand all teaching/student material including, certificates may only be obtained from DT4EMS, LLC.
I understand that my mere presence in the course does not constitute successful completion.
______

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After successful completion, you would coordinate and train EMS/Fire and health care providers how to escape violent encounters they face in the medical field (while maintaining a professional image).

We don't want bullies or tough guys. We are looking for people to train staff how important their safety truly is. In our you will see news reports of assaults on EMS/Fire and healthcare providers from all over the world. We have articles and videos there as well. It is strongly suggested you become familiar with the info located on the homepages as well as the forums.

The DT4EMS Instructor course is a 40-hour course consisting of the following:

• Setting up the proper learning environment

• Basic lecture skills

• Teaching the skills of DT4EMS

• Recognizing and teaching different types of students

• Safety Concerns/Practices

• Practical Evaluation Skills

• PowerPoint Presentation Skills

• Use of A/V Aids

• History of DT4EMS

• Understanding the need for DT4EMS

• Teaching Assault Response Guidelines

• Documentation Training

• Teaching Survival Mindset

• Setting up and conducting scenario based training

• Proficiency training in the drills and skills taught in a DT4EMS Course.

Fee: $399.00 per person (fee does not include travel, lodging or meals)

Participants will receive a Manual with video CD, PowerPoint Presentation and Certificate upon successful completion.

When teaching an approved course, each participant in your course must have their own course materials. These materials are purchased from DT4EMS, LLC at a cost of $25.00 per packet. When the orders are less than 20. When the order is over 20 the cost drops to $18.50 for each packet. For liability reasons we do not allow the course materials to be placed in a library setting. If you have any questions you may email or call 417-699-4877 ask for Kip.