Blended Standard First Aid & CPR/AED Level C course
Mar 6th, 2026 - First come, first served
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Marital Status
*
Single
Married
Common-Law
Widowed
Separated
Divorced
Date of your original entry to Canada
*
-
Month
-
Day
Year
Date
Country of origin
*
Last country of residence (Before Canada)
*
Status in Canada
*
Permanent Resident
Work Permit (Open)
Work Permit (Closed)
Protected Person
Refugee Claimant
Other
If you are a permanent resident, please provide the date you became a permanent resident.
-
Month
-
Day
Year
Date
Client ID number or UCI number, please refer to your Work Permit or PR Card
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Are you a Home Care Worker?
*
Yes
No
Native Language
*
Please upload either your Work Permit or the front and back of your PR card.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Confidentiality
All client information collected is confidential and securely stored, except when related to the harm of a minor. If your personal information needs to be shared for assistance purposes, your written approval will be requested beforehand. As a client, you have the right to refuse to answer any questions you find inappropriate. Statistical information is collected anonymously, except for the following required by Immigration, Refugees, and Citizenship Canada (IRCC) for newcomers with permanent resident status:Your name, Contact information, Immigration client number and proof of your immigration status (original immigration papers must be presented for copying). Our services are completely free, and we cannot accept any form of payment or gifts. ACKNOWLEDGEMENT! have read and accept the terms under which services will be provided.
Signature
*
Submit
Should be Empty: