On-site CPR Course Request

1
Your Name* This field is required.
First Name
Last Name
2
Phone Number* This field is required.
Area
Phone Number
3
Email* This field is required.
example@example.com
4
What is your preferred method of contact* This field is required.
Email
Phone Call
Text
5
Are you a business or individual?* This field is required.
Business/Organization
Individual
6
What is the name of the organization?* This field is required.
7
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
8
What class do you need?
Please Select
Please Select
CPR & AED (for laymen)
CPR, AED & First Aid (for laymen)
BLS (For Healthcare workers, Lifeguards & First responders)
ACLS (Advanced CPR for Medical Professionals)
PALS (Pediatric Advanced CPR for Medical Professionals)
Hands-Only CPR (Accelerated course w/ Compressions & AED Only)
9
Which class are you interested in?* This field is required.If more than 1, select all that apply.
CPR & AED (for laymen)
CPR, AED & First Aid (for laymen)
Pediatric/ Children & Infant Only (Babysitters, Daycares, Child Centers)
BLS (For Healthcare workers, Lifeguards & First responders & Caretakers)
ACLS (Advanced CPR for Medical Professionals)
PALS (Pediatric Advanced CPR for Medical Professionals)
Hands-Only CPR (Accelerated course w/ Compressions & AED Only)
Friends & Family (Non-certification CPR course. Flexible course for anyone.)
10
What do you want to cover?* This field is required.
Adults Only (Workplace CPR or Teen/Adult facilities)
Adults & Children (Full CPR course)
Bloodborne Pathogen BBP
STOP THE BLEED
11
What are you interested in covering?Friends & Family
Adults Only
Child & Infant
All: Adults, Child & Infant
12
Adult Only CPR & AED

Recommended for:

Those who work in low risk enviroments with teenagers or adults being the primary populations. Offices, Highschools, gyms, retail or stores, sports leagues, senior living centers etc....

Course Covers

Compressions

Rescue Breaths

AED (Defibrillator)

Choking relief

Opiod Overdose

Course length:

1.5-2 hours
13
Adult CPR/AED & First Aid

Recommended for:

Those who work in areas where teenagers or adults are the primary population. Offices, Highschools, retail or stores, gyms, sports leagues, senior living centers etc....

Course Covers

Compressions

Rescue Breaths

AED (Defibrillator)

Choking relief

Opiod Overdose

First Aid treatment for common illness and injuries

Course length:

2-3 hours
14
Full CPR & AED

Recommended for:

Those who work regularly or reside with infants or children and adults. Schools, Recreational centers, pools, daycares, etc....

Course Covers

Compressions

Rescue Breaths

AED (Defibrillator)

Choking relief

Opiod Overdose

Course length:

2 hours
15
Full CPR/AED & First Aid

Recommended for:

Those who work regularly or reside with infants or children and adults. Schools, Recreational centers, pools, daycares, etc....

Course Covers

Compressions

Rescue Breaths

AED (Defibrillator)

Choking relief

Opiod Overdose

First Aid treatment for common illness and injuries

Course length:

2.5-3 hours
16
Basic Life Support (BLS)

Recommended for:

Those who work in healthcare, are first responders or any other licenses professional. Hospital, Dental or Medical offices, EMTs, Firefighters, Lifeguards, Nursing Homes, private care etc...

Course length:

2-3 hours
17
Advanced Cardiac Life Support (ACLS)

Recommended for:

Those who work in healthcare, are first responders or any other licenses professional. Hospital, Dental or Medical offices,Surgery centers etc...
18
Pediatric Advanced Life Support (PALS)

Recommended for:

Those who work in healthcare, are first responders or any other licenses professional. Hospital, Dental or Medical offices,Surgery centers etc...
19
Hands Only CPR

Recommended for:

Those interested in learning the essentials to saving a life. Community events, clubs & organizations, schools, parents, students, vendors etc...

Course Covers (Teenagers & Adults only: Not reccomended for children)

Compressions

AED (Defibrillator)

Choking relief

Opiod Overdose

Course length:

1 hr
20
Pediatric CPR

Recommended for:

Those who work with primarily with chldren and infants. Daycare staff, teachers, school staff, camp counselors, coaches, and youth organization leaders.

Course Covers (Infants & Children)

Compressions

Rescue Breaths

AED (Defibrillator)

Choking relief

Opiod Overdose

First Aid for common illness and injuries (Optional)

Course length:

2- 2.5 hr
21
Friends & Family CPR

Recommended for:

Anyone interested in learning how to save a life and feel more confident during an emergency without the need for a certification. Ideal for parents, grandparents, familes and community members etc...

Course Covers (Flexible: Choose, adults, child & infant or both)

Compressions

Rescue Breaths

AED (Defibrillator)

Choking relief

Opiod Overdose

Course length: (Depending upon the number of modules)

1 hr - 2 hrs
22
Type a question
CPR & AED (for laymen)
CPR, AED & First Aid (for laymen)
BLS (For Healthcare workers, Lifeguards & First responders)
ACLS (Advanced CPR for Medical Professionals)
PALS (Pediatric Advanced CPR for Medical Professionals)
Hands-Only CPR (Accelerated course w/ Compressions & AED Only)
23
Will the students require a CPR certification?
Yes
No: I Just want to learn
24
What course type are you interested in?* This field is required.
Traditional:100% In Person
Hybrid: 50% online & 50% In Person
Virtual: 100% Online
25
Approximately how many students will be joining the course?
26
1) Desired Date & Time of classPreferred time & date
Date
Year
Month
Day
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
10
20
30
40
50
Minutes
AM
AM
PM
27
2) Desired Date & Time of class
Date
Year
Month
Day
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
10
20
30
40
50
Minutes
AM
AM
PM
28
3) Desired Date & Time of class
Date
Year
Month
Day
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
10
20
30
40
50
Minutes
AM
AM
PM
29
Does your space have a TV screen with HDMI access?* This field is required.(If not, CPR 2 YOU will bring a Projector screen)
Yes
No
30
Optional- You can attach a photo of the training spaceThis Helps us understand the layout and best prepare for your class.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Browse Files
Cancelof
31
Are you interested in any CPR products?Select all that apply to learn more
AED/Defibrillators
Rescue breaths barrier devices
First Aid Kits
STOP THE BLEED kits
Bag Valve Mask (Ambu Bags)
Sports emergency Triage Kits
CPR Posters
CPR Quick Pull Reference Guides
CPR & Emergency Care Books
32
How did you hear about us?* This field is required.
Google Search
American Heart Association
Direct referral
TV/Radio
Facebook/Instagram
Returning Customer❤️
Other
Should be Empty: