June Zoom CPR/First Aid Class

Personal Information

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• * Address 1:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:
• * Cell Phone:
• *

  Are you registering other participants

  • Yes
  • No
• If registering more than one person cards will be mailed to the school please give name of school and mailing address
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• *

  Which day are you registering for

  • Tuesday 12:30p.m. - 1:30p.m.
  • Friday 12:30p.m. - 1:30p.m.
  • Saturday Morning 9:00-11:00

• Fee

  Type	Fee
  CPR/First Aid for Childcare	$40.00
  CPR/First Aid for CDA	$55.00

Participant Information

You may add a maximum of 50

Custom Information 1

• *

  Registration fee is non refundable, class can be rescheduled

  • I understand my registration is non refundable
  • I understand class can be rescheduled if necessary

• Why are you registering for this class

  • To work in childcare only
  • To obtain or renew my CDA and work in childcare

Custom Information 2

• Please note all classes are scheduled in the Central Standard Time Zone

Business Information

• * What is the date of the class you are registering for?