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2. Your Name*
3. E-mail Address*
5. Phone Number*
6. Home Address*
8. Courses*

   1. Basic First Aid - $35
   2. CPR/AED - $35
   3. CPR Pro - $45
   4. Combo CPR/AED and First Aid - $65
9. Instruction Type

   1. Blended (individuals) Info. link sent by e-mail within 24 hours of payment.
   2. Group (10 or more) You will be contacted by phone within 24 hours of payment.
11. Hands On / Skills Session Training

    Once you have finished your online classes, you will be required to complete a hands on/skills session before receiving your certification card. Please select the date that best fits your schedule and expected completion time.

13. Hands On/Skills Session Training Dates (please select one).
    -- Select One --Monday, December 6th, from 9 to 11 am

    You must select a date in order to register for any of the CPR or first aid classes. If you need to change a date after registering - please contact us at 407-585-1422. Due to conflicts with other programs offered, we cannot accommodate any special date or time requests for these sessions. For businesses or groups of 10 or more - please contact us directly to schedule class. Five student maximum per class. Sign up will be on a first come, first serve basis. Social distancing will be strictly enforced and all students shall wear a mask/face covering.

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15. 1. Receive an email copy of this form.
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