Community First Aid, CPR, AED Certification Class Registration

First Aid, CPR, AED Certification Registration

Choose May 10 @ 6:30pm OR May 23rd @ 6:30pm.
Your Full Name

First NameLast Name
Your Email
example@example.com
Your Phone Number
Please enter a valid phone number.
Please choose your township:

Lower PottsgroveUpper PottsgroveWest PottsgroveOther
Participants' Name, Age(s) if under 18.
Any participant and/or guardian do hereby agree to the following:

1. To assume all risks and responsibilities of possible damage or injury involved through participation in said activity. I understand I am to furnish my own insurance in case of injury. I understand and request permission to participate in the above activity with the full knowledge that the said activity could result in damage or injury to participate.

2. Agree to indemnify and hold harmless the Pottsgrove Recreation Board, its departments and agents from liability for personal injury or property damage resulting from myparticipation in said activity.

3. Waive the right to dispute all proper charges once he/she/they have registered and/or participated in the PRB program for which this registration form is received.

4. Agree to allow Pottsgrove Recreation Board to use any photos taken at an activity for future publications.

5. By providing any email address, I agree to receive emails from Pottsgrove Recreation Board. Email will not be shared with any other entities.
Signature

Clear
My Products
prevnext( X )
May 10 @ 6:30PM Pottsgrove Middle School Library
$60.00 Quantity

May 23 @ 6:30pmPottsgrove Middle School Library
$60.00 Quantity

Total

$0.00
Should be Empty:

First Aid, CPR, AED Certification Registration