Education Class Registration

Education Class Registration
EMPLOYEES AND VOLUNTEERS DO NOT USE THIS FORM.

Please fill out the information below. You will select your course(s) and pay on the next page.
First Name*
Last Name*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*

Confirmation Emailexample@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
Multiple Enrollees Information (click "add row" for more) *

All course information including dates and times is hosted on our website www.hcesd8.com or published through our social media. Please check there first before signing up.

If you have any quesitons regarding the course(s) below, please email education@hcesd8.com before purchasing.

** skills verification requests, please email education@hcesd8.com to schedule an appointment.
A Scheduled In-Person ClassSkills only and I'm requesting a date to schedule to do itA drug test or TB test
Scheduling an in-person Class: Use our website to pick the date to make sure we are signing you up for the right course.

MonthDayYear
Date
Skills Only: For skills verification only, we schedule them on a case-by-case basis. To start, select a date that would work best for you and we will let you know. Feel free to add comments at the bottom to add further availability. *

MonthDayYear
Date
Drug test or TB Test: We schedule these on a case-by-case basis. To start, select a date that would work best for you. Feel free to add further availability in the comments below. We will reach out to confirm once we have received your submission. *

MonthDayYear
Date
If you plan to pay upon arrival at the class, please go to the bottom of the list and select 'Payment Upon Arrival'. In the notes, fill in the course name and the date you are signing up for.

Select the course(s) you would like to register for below. Note: any refunds requested will be provided minus any transaction fees accrued during the purchase and refunding process.

BLS for Healthcare Provider CPR

AHA In-Person BLS CPR course

$65.00 Quantity

BLS CPR Skills Verification Only

AHA Heartcode BLS Skills Verification Only

$40.00 Quantity

ACLS Provider

AHA In-Person Advanced Cardiac Life Support Course

$150.00 Quantity

ACLS Skills Verification Only

AHA Heartcode ACLS skills verification only

$90.00 Quantity

PALS Provider

AHA In-Person Pediatric Advanced Life Support Course

$150.00 Quantity

PALS Skills Verification Only

AHA Heart Code PALS Skills Verification Only

$90.00 Quantity

GEMS Course

In-Person Geriatric Education for Emergency Medical Services

$200.00 Quantity

AMLS Hybrid Course

Hybrid Advanced Medical Life Support

$200.00 Quantity

PHTLS Hybrid Course

Hyrbid Pre-Hospital Trauma Life Support

$200.00 Quantity

TB Test

Skin test w/ reading

$30.00 Quantity

Student Drug Test

10-pannel urinalysis

$60.00 Quantity

Pay Upon Arrival

If you plan to pay using cash or check, add this to your card to sign up. Put in the notes what class you are signing up for.

$ Free Quantity

Enter coupon

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Any notes you would like to attach to this purchase? (not required)
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