EmailMe Form - ATV / ROV Safety Instructor Application

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 *

Prefix First MI Last

Date of Birth *

MM / DD / YYYY

Eye Colour *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Main Phone *

### - ### - ####

Alternate Phone

### - ### - ####

Occupation *

Company Name

Company Phone

### - ### - ####

Company Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Education (Check all that apply) *

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. *

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 *

Province *

Years Experience Driving *

Has your licence been suspended or revolked in the last 5 years? (If yes please explain)

ATV / ROV Experience *

	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) *

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

MM / DD / YYYY