First Aid Course Registration Form

Participant Registration Form

Please complete the form below to register for our First Aid Courses.
Participant's Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*
E-mail*
example@example.com
Phone Number*
Have you taken previous training?*
Date of last training and organization
Full Mailing Address*

Street Address

CityProvince

Postal Code
Parent/Guardian Information
Name*

First NameLast Name
Course

Please do a separate form for each individual participant.
Please Select Course Below:
Please select all available days:

Saturday July 9
Additional Participants
Please note- this section is for participants from the same family only.
Notes
Medical Information
Is there any medical Information/allergies of which the instructor should be aware?

YesNo
If yes, please list medications that must be brought with the participant:
Waiver/Confirmation
I hereby release Aquatic Adventures/Flex First Aid from all claims for damages rising from participation of the applicant hereon during any program or in any facility or at any location where a program is being held.
By acknowledging and signing below, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.
Signature*

Clear
Should be Empty:

Participant Registration Form