Private CPR Class Request Form

Private CPR Class Request Form
Contact Information

Please list the organization or department you are with, along with a main contact for your area. Submitting this request will not guarantee you a class. We will still need to reach out to you and confirm a date and time for the class. At this time our lead time is about a month. There is a minimum requirement of four participants to host a class.
Organization Name *
Main Contact: Name *

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Type of Class

Please choose one of the following classes that you would like us to hold for your group. We teach blended learning classes. This means all the classes below will include a 1-2 hour online instruction portion that will need to be completed prior to the in person portion of the class.
Below are the Types of American Red Cross Classes we can teach:*

Adult and Pediatric First Aid/CPR/AEDAdult First Aid/CPR/AED
Dates and Times
We are curretly in the process of finalizing dates for Spring 2024. Please submitt your request and Sarah Sustrick will respond back with a timeline of when dates are available to choose from.

Thank you!

UREC Aquatics
We have the following dates available for classes this Fall 2024 Semester. Please choose one of the following.*

Friday May 31st 4:00p-7:00pSaturday June 15th 1:00p-4:00pSaturday June 22nd 1:00p-4:00pFriday June 21st 5:00p-8:00pSaturday June 29th 1:00p-4:00pFriday June 28th 5:00p-8:00pNone of these work for our organization
We have the following dates available for classes this Fall 2024 Semester. Please choose one of the following.*

None of these work for our organization
Our classes take roughly 3 hours. Below please provide a general time frame your group would be available on the date you picked.
Pricing and Payments

Pricing:

We have a minmum of 4 partipants to hold a class.

It is one flat fee based on group size.

# of Participants	Class Cost
4-9	$75.00 per participant
10-15	$70.00 per participant
16-20	$65.00 per participant

Approximately how many participants would you like to be registered for this class? We can host a maximum of 20 and minimum of 4 participants in one session.*
How would you like to pay for this class?*

Department TransferCredit Card
Should be Empty:

Private CPR Class Request Form

Contact Information

Type of Class

Dates and Times

Pricing and Payments