Child Passenger Safety Certification Training Interest Form

Thank you for your interest in becoming a nationally certified Child Passenger Safety (CPS) technician. You are joining a group of dedicated people who all have one thing in common: they care deeply about kids and want to make sure they are safe on every ride. CPS technicians use their knowledge and expertise at a variety of community-based activities, such as child safety seat checks, where parents and caregivers receive education and hands-on assistance. CPS technicians also keep up-to-date on the latest technical information about child passenger safety through seminars and other continuing education opportunities. All CPS technicians must take and pass the 32 hour CPS Certification Course and pay a course fee of $250, which includes materials and food.
1.Which class(es) are you interested in(Required.)
2.Full Name(Required.)
3.Company or Organization (if applicable)
4.Position or Title
5.Phone Number(Required.)
6.Email Address (will be the main form of communication)(Required.)
7.How did you hear about this training?(Required.)
8.Why do you want to become a Child Passenger Safety Technician?(Required.)
In case of need, there are a limited amount of scholarships available.  For questions Contact Kerilee Burton kburton@utah.gov, 801-505-3315
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