Registration Form
Fill out the form carefully for registration
Student Name*
*
First Name
Middle Name
Last Name
Student’s Mobile Number:*
*
Format: (000) 000-0000.
Student’s Address:*
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Courses Offered
Please Select
Healthcare Certification Courses
1. CNA – Certified Nursing Assistant
Online & In-person – $1,300.00
2. BLS Renewal (AHA BLS Course)
Blended Learning – Online & In-person – $130.00
3. BLS Renewal (AHA BLS Course)
Classroom – In-person – $105.00
4. BLS Provider – Skills Only
– $80.00
5. BLS Provider (AHA CPR / BLS for First-Time Students)
Classroom or Online – $130.00
6. BLS - CPR (For CNA Students Enrolled with CPR Partners)
– $175.00
7. NRP – Neonatal Resuscitation Program
– $175.00
8. TNCC – Trauma Nursing Core Course
– $220.00
9. PALS Certification (Pediatric Advanced Life Support)
– $105.00
10. PALS Recertification
– $90.00
11. ACLS Certification (Advanced Cardiovascular Life Support)
– $100.00
12. ACLS Recertification
– $85.00
13.
CPI: $125 – Includes Blue Card + Handbook/Booklet
Please List the Course(s), Date(s), day(s), and Time(s) you're Registering for: (ex: BLS, Monday, 2:00pm to 3:30pm; (optional if signing up for CNA course training)*
Comments (Add any information or special accommodations requests)
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Student’s Email:*
*
example@example.com
Should be Empty: