CPR/BLS Registration Form
Class Policy: Students arriving more than 10 minutes late may not be admitted and will be marked as a no-show. No-shows and late arrivals are non-refundable and non-transferable.All payments are required to reserve your seat and are forfeited if you do not attend your scheduled class. Rescheduling is subject to availability and must be requested in advance
Name
*
First Name
Last Name
Email
*
example@example.com
DOB
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What is your occupation?
*
Please Select
Student- High School/ College
Nurse
Hairstylist
Med Assistant
CNA
Construction
Welding
Electrician
Doctor
Daycare Worker
Office Worker
Church Worker
Other
Which class are you interested in?
*
Please Select
1st Time CPR
Renewal CPR
1st Time BLS
Renewal BLS
First Aid
Renewal First Aid
Adult and Child CPR. First Aid and AED
Adult CPR and First Aid
Class Scheduler
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
My Products
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( X )
BASIC LIFE SUPPORT- CLASS or JUST SKILLS
$90.00
$
90.00
Quantity
1
2
3
4
5
6
7
8
9
10
FIRST AID CLASS or JUST SKILLS
$50.00
$
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
ADULT -CHILD CPR, FIRST AID/AED CLASS or JUST SKILLS
$75.00
$
75.00
Quantity
1
2
3
4
5
6
7
8
9
10
ADULT CPR CLASS or JUST SKILLS
$60.00
$
60.00
Quantity
1
2
3
4
5
6
7
8
9
10
RENEWAL ADULT-CHILD FIRST AID/ AED CLASS
$70.00
$
70.00
Quantity
1
2
3
4
5
6
7
8
9
10
ADULT CPR FIRST AID or JUST SKILLS
$65.00
$
65.00
Quantity
1
2
3
4
5
6
7
8
9
10
RENEWAL FIRST AID CLASS
$45.00
$
45.00
Quantity
1
2
3
4
5
6
7
8
9
10
RENEWAL BLS- BASIC LIFE SUPPORT
$85.00
$
85.00
Quantity
1
2
3
4
5
6
7
8
9
10
RENEWAL ADULT CPR CLASS
$55.00
$
55.00
Quantity
1
2
3
4
5
6
7
8
9
10
RENEWAL ADULT CPR AND FIRST AID
$60.00
$
60.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
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