AHA HeartSaver First-Aid, CPR & AED Cert. Course Application 2026-2027

Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate of Birth
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
School DIstrict of Residence
For example: Reading School District
Have you ever attended a K-12 School in Pennsylvania?
Do you currently hold a valid Driver's License or State ID Card? (You will be required to present this prior to testing).
What ethnicity are you?
Each HeartSaver course consists of three evening classes (5:30 pm - 8:30 pm).

HearSaver Certification Course Fee: $115

This fee includes the textbook and exam administration.
February Course Dates:

Mon., Februay 8, 2027 - 5:00-7:30pm
Tues., February 9, 2027 - 5:00-7:30pm

Wed, February 10, 2027 - 5:00-7:30pm
Which course do you select?

AHA HeartSaver First-Aid, CPR & AED Certification Course

$115.00

Total

Please indicate any comments, concerns, special requests or accommodations below.
Should be Empty: