Seizure First Aid and Safety Training Request Form
Epilepsy Alliance Louisiana (EAL) offers seizure first aid and safety trainings for community members at no charge.  This training prepares participants to recognize common seizure types and respond appropriately.  
Email Address Here: *
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Name of School *
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Address of School *
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Phone number for school *
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Are you requesting as the parent of a child? *
Parent's Information
Your name *
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Preferred contact information (phone number and/or email address) *
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Child's Name *
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Child's Grade
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Child's teacher(s)
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Other personnel you would like to request receive this training:
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Who is the best person at your child's school to contact about scheduling? *
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Is there any other information you would like us to have?
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School staff/Teacher
What is your name and job title? *
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Preferred contact information (phone number and/or email address) *
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Preferred Date(s) (if known)
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Number of participants (if known)
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Are you interested in completing the training using Zoom?
Is there any other information you would like us to have?
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Thank you
A representative from our office should contact you within 1-2 business days.  If you need to reach us, you can call 225-298-5499 or email info@epilepsylouisiana.org 
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