CPR Class Registration Form

CPR Student Registration Form

Fill out the form carefully and verify certification type for registration
Student Name*

First NameMiddle InitalLast Name
Company
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail*
Phone Number*

Area CodePhone Number
Course Class Date*
Class time 5:30pm-8:30pm
Comments
Contact for pricing (260) 347-5010

Healthcare provider BLS

Heartsaver CPR/AED Adult/Child/Infant

Heartsaver First Aid (Upon Request)

All classes held at 304 E. North St. Kendallville IN. 46755 unless noted.

Cash or Check accepted. Please make check to Kendallville Volunteer Fire Dept INC.

MUST BE 16 YEARS OR OLDER.

Any questions email: cpr@kendallville-in.org
Should be Empty:

CPR Student Registration Form