CPR Class Request Form

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Your Contact Information:* This field is required.
First Name
Last Name
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E-mail* This field is required.
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Phone Number* This field is required.
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Where will the class take place?* This field is required.We come to you! Please enter the address below.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Is this location a home (private residence) or a business/office?* This field is required.
HomeBusiness/Office
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Does this location have access to tables and chairs for all class participants?* This field is required.
YESNO
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How many people will be participating in the class (including yourself if applicable)?* This field is required.Each participant will need to register with a separate email address and phone number.
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Is this class for renewal (participants currently hold a certification) or new certification (participants have never been certified OR previous certification has expired).* This field is required.
Renewal (participants currently hold a certification)
New Certification (participants have never been certified OR previous certification has expired)
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What type of class are you requesting?* This field is required.For a full description for each type of class, please visit our website.
Adult & Pediatric First Aid/CPR/AED ($99 per participant)
Adult & Pediatric CPR/AED ($89 per participant)
Adult First Aid/CPR/AED ($89 per participant)
Adult CPR/AED ($79 per participant)
Renewal ($79 per participant)
Skills Session Only ($69 per participant)
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If you have a discount code for your class, please enter it below.
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How did you hear about us?
Please Select
Please Select
Google Search
Social Media (Facebook, Instagram, X, etc.)
Referral
Red Cross Website
Direct Mail
Other
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Please choose your preferred date and time for your class:* This field is required.*We will do our best to schedule your preferred date and time; however, your selection is not guaranteed. PLEASE NOTE - Class will not be scheduled and confirmed until full payment is received from all participants. Please allow 2 - 4 hours for the class. All classes are in a blended learning format. **THE ONLINE PORTION MUST BE COMPLETED PRIOR TO THE SCHEDULED CLASS.
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Please choose an alternative date and time for your class.* This field is required.
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Terms and Conditions* This field is required.1. Registration and scheduling of a class are not complete and/or confirmed until payment is received for all participants. An invoice for all participants will be sent to the provided email address. Invoices are payable via email. 2. Once a class has been scheduled and confirmed, cancellations are only accepted within 3 days of the scheduled class. If cancellation occurs, the following amounts are deducted from the original payment: 50% from 1 to 3 days before scheduled class starts; 100% from 0 to 0 days before scheduled class starts. Scheduled classes may be re-scheduled at no additional fee if requested within 1 day of the scheduled class. 3. For all blended learning classes, participants must complete the online portion of the course prior to attending the in-person skills session, and provide proof of completion. 4. Participants will be required to complete the hands-on skills test to confirm knowledge of proper techniques for certification and/or certification renewal. If participants fail this initial skills evaluation, the participant will be required to transfer the registration into a future class for a small fee, but there will be no refunds. 5. Upon successful completion, participants will receive an email from the American Red Cross within 24 hours with access to the certification.
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