EmailMeForm
ATV / ROV Safety Instructor Application
Use this form to apply to become a certified CASI Instructor. Once you have completed the application, please provide any additional instructions on a separate sheet and email it to generalmanager@quadcouncil.ca. Contact the CQC office for any questions regarding this application: generalmanager@quadcouncil.ca or (888) 613-2722
Instructor Certification: I understand and certify that I am;
*
Yes
No
At least 18 years of age
A "Team Player"
Will maintain a good working relationship with my Provincial Rider Federation.
Possess excellent coaching, evaluating and communication skills.
Have a valid standard first aid certificate with CPR training or equivalent.
Have the time flexibility to attend update seminars throughout the year.
Have basic computer skills to be able to enter data data into the CASI student database
Able to pay the fee for taking the training course; which is $1,550.00 and is payable at least 1 week prior to the training commencment. (unless other arrangements are made with the Chief Instructor)
Name
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First
MI
Last
Date of Birth
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Eye Colour
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Please select
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Address
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Street Address
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Marshall Islands
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Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Email
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Main Phone
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Alternate Phone
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Occupation
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Company Name
Company Phone
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Company Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Education (Check all that apply)
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High School
College
University
Other specialized Training
Criminal Record:
You must provide a copy of a current (6 months) CPIC criminal record check or equivalent with vulnerable sector check.
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I have it and I will submit it to: info@atvquad.ca
I will apply for it immediately and submit it to: generalmanager@quadcouncil.ca (Prior to the training taking place)
Drivers License Number
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Province
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Years Experience Driving
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Has your licence been suspended or revolked in the last 5 years? (If yes please explain)
ATV / ROV Experience
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Yes
No
Do you currently own an ATV / ROV?
Have you attended a safety training course?
Instructor Apparel:
Once you have successfully completed the CASI Instructor Training Course you will be entitled to receive either a jacket or a jersey which must be worn when you are on the range providing instruction to students
Yellow Training Jacket
White Training Jersey
Please note that the clothing does fit small and it is recommended that you order 1 size larger than what you would normally wear
Size:
Medium
Large
Extra Large
2 Extra Large
3 Extra Large
If you would like to purchase more training material items, such as additional jersey or jacket, ball caps, and or instructor range pouch, you will be able to do so in the Instructors corner of the AQCC website. www.atvquad.ca
Riding Style:
Please tell us how many years you have been riding and what type of riding you enjoy: (Bush trails, railbeds, exploring, muddy or technical riding)
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Why do you want to become an Instructor? (Be specific)
Do you have any further comments?
I declare under the penalty of perjury under the laws of the Province of Ontario that
the information provided on this application is true and correct. I further agree to abide
by Instructor Standards and Responsibilities of the OFATV Safety Program.
By checking this box, I am agreeing to the declaration as stated
Today's Date
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