CPR Registration Form

Please complete this form and be sure to include the on-site address. Please note, only a minimum of two (2) and maximum of eight* (8) participants are allowed per class.

Contact Brantley's Life-Saving Services at saved1life@gmail.com BEFORE submitting this form to discuss date requested if you do not see the date as available per the course calendar.

*RSV class maximum is three (3) participants, all must have a video-capability equipment (smart phone, webcam).

Name*

First NameLast Name

Name*

First NameLast Name

Name

First NameLast Name

Name

First NameLast Name

Name

First NameLast Name

Name

First NameLast Name

Name

First NameLast Name

Name

First NameLast Name

Contact Email*

example@example.com

Address*

Street

Street Address Line 2

CityState

Zip Code

Telephone*

BLS for Healthcare Providers

$70

CPR/First Aid (Blended)

$40

CPR/First Aid (Full)

$60

Remote Skills Verification (RSV)

$80

Class Date*

Date

On-Site Location Name*

Address*

Street

Street Address Line 2

CityState

Zip Code

Telephone

On-site location MUST be able to provide adequate space for SOCIAL DISTANCING

My Products*

BLS for Healthcare Providers Product Image

BLS for Healthcare ProvidersBasic Life Support for Healthcare providers. This is a blended-learning session. Student MUST complete online portion PRIOR to skills check-off session.

$70.00 Quantity

First Aid, CPR, AED Training (Blended Learning) Product Image

First Aid, CPR, AED Training (Blended Learning)First Aid, CPR, AED Training and Certification for non-Healthcare Providers. This is a blended-learning session. Student MUST complete online portion PRIOR to attending in-class skills session.

$40.00 Quantity

First Aid, CPR, AED Training (Full Class) Product Image

First Aid, CPR, AED Training (Full Class)First Aid, CPR, AED Training and Certification for non-Healthcare Providers. This is a full, in-person class (30 min lunch break included).

$60.00 Quantity

Remote Skills Verification (RSV) Product Image

Remote Skills Verification (RSV)BLS for Healthcare Providers are NOT eligible. First Aid, CPR, AED Training and Certification for non-Healthcare Providers ONLY. This is a blended learning session. Student MUST complete online portion PRIOR to RSV session. Video-capability equipment are required (smart phone, webcam). All training equipment MUST be returned PRIOR to receiving certification.

$80.00 Quantity

Subtotal

$0.00

Shipping

$0.00

Total

$0.00

Credit Card

COURSE REGISTRATION FORM

Credit Card