One-on-One CPR Registration Form

Student Name/ Primary Caregiver*

Student Name/ Secondary Caregiver

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Primary E-mail Address*

Secondary Email Address

example@example.com

Which Agency are you planning to foster with? (DFCS, Children's 1st, HOPE Foster Care, Necco, etc.)*

What is case manager/ recruiter's name?

What is your case manager/recruiter's email address?

What is your case manager/recruiter's phone number?

Information about the CPR Courses

Please be advised that you will receive an invoice after registration. Your registration is not complete until payment is received. If you are with an agency that reimburses for the cost of the class, you will receive a receipt on the day of the class. Also, you may receive an email indicating that the cost of your class has been covered by your agency. Once you have received this email, you may consider yourself fully registered. It is critically important to indicate which agency you're fostering with in order to understand your payment procedure. Email Deja Williams at: GeorgiaKinshipProject@outlook.com if there are additional questions or concerns.

Basic Life Skills and First Aid (One-on-One)- $90 per adult (Required for Foster Parents)

Basic Life Skills ONLY- $65 per adult

First Aid Skills ONLY- $35 per adult

Which Class are you registering for?

Please be advised that all new foster parents should register for BLS and First Aid unless they are able to provide proof that they've received either certification from another provider.

List your proposed dates for the one-on-one class.

List a minimum of two dates.

List your locations for the one-on-one class.

Indicate if you would like for the class to be taught at your home, the Georgia Kinship Project Office, or other location in the community.

Are you a medical professional?

YesNo

The course for which you are enrolled may include physical strain and/or emotional stress. If your physician has recommended that you avoid strenuous activity or limit your activity in any way, please follow the recommendation of your physician. CPR training is hard work due to the practice of providing compressions. If you have a medical or coronary history that may be aggravated by this course, you should consult your physician and ask his/her advice as to whether you should participate in a CPR course. If you have reservations about being able to perform CPR on a cardiac arrest victim, you should consider this before beginning the course.

If you have recently had any type of infectious disease, including upper respiratory infection or open sores on your mouth or hands, or COVID-19 exposure, it is imperative to defer manikin practice until you are well.

I, the undersigned, have read and understand the above liability statement for CPR class, and still wish to participate in this course. I will not hold the organization or the instructor(s) responsible for any physical strain, cross-infection, and/or emotional stress which may occur as a result of participating in this course.

Georgia Kinship Project understands that situations arise and will sometimes put you in a position to cancel or reschedule. We are unable to provide refunds for any classes, however we are able to reschedule classes. If you need to reschedule, please contact Georgia Kinship Project by phone or email (478-334-9889 / GeorgiaKinshipProject@outlook.com) within 48 hours of the date of the class. If you do not make contact within 48 hours of the class, you will be charged the course rate ($25) for rescheduling. There will be no refunds for no-call/ no-shows.

Do you accept the terms and conditions above?*

YesNo

One-on-One CPR Course Registration Form

Waiver of Liability

Refund Policy