Registrant Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Enter Email Confirm Email

The email entered in this box above will be used to send the confirmation.receipt. If you are booking an employee may we suggest that you enter your email here to receive the confirmation.receipt. You can forward a copy to your employee if needed.

Registrant's Email: Please re-enter your email even if it is the same as the above. If your personal email is different from the above email address, please enter it here as this email will be used to create your Red Cross account. If you already have a Red Cross Account, perhaps different from the above email, please provide it here. You are required to remember this email to access your Red Cross Account.*

This email will be for the course participant. A Red Cross account is created based on the email provided. This email must not be used by any other person as it defines your account alone and no one else's. You must not change this email and must use this email to access your certificate within your Red Cross Account. Should you choose to change your email within your account, after your account has been created, Breath for Life will not be able to help you access your account or your certificate – as you will be locked out and this will prevent us from helping you.

As a Digital Manual is available for free and will appear on your confirmation/receipt the cost of a Hard Copy textbook will be extra.*

The digital manual will serve my needs and I do not want to pay extra for a Hard Copy Textbook
I am interested in the Hard Copy textbook:Textbook is final sale

Select how you would like to Receive your Course Material (Textbook)*

Shipped to an address (additional charge ($35)
I will pick up the manual at the Breath for Life Inc. office
I am taking my pre-requisite course with Breath for Life Inc. I would like to have the manual brought to the course so I can pick it up.
I will receive the manual on the first day of the Course

Please enter the date when you will be picking up the manual or when you will be taking the pre-requisite course with Breath for Life.*

Materials Shipping Address:*

Use above address
Different Shipping Address

Shipping Address*

Street Address City State / Province / Region ZIP / Postal Code Country

You will be emailed when your package is ready for pickup

Optional: This section is for Breath for Life's records. No email or correspondence will be sent based on the information entered.

Provide your Company Details

Breath for Life is required to keep on file a record of all registrants. By entering company information this will be an additional way to search for registrants if certification information is requested.

Company Name*

Company Contact*

First Last

Company Email*

Advanced First Aid Course ($950.00+GST)

Price:

Hard Copy Textbook ($150 + Tax)

Price:

Standard First Aid Level C CPR Course ($130 + GST)

Price:

Shipping Manual ($35.00 + GST)

Price:

Total

$ 0.00 CAD

Please Note:

Payment must be received in advance to attend this course. Provide debit or credit card information in the payment section below and click on the submit button to complete your registration and payment.

CANCELLATION/RESCHEDULING POLICY

Please read the Policies governing this course. Breath for Life Does commits to delivering the course that you register into. Breath for Life thanks you for your patronage.

I have read and understand the policies.*

Yes

By entering your name in the space provided, which represents your signature for yourself or someone else, you accept the terms and conditions of the policies which form a contract between you (the registrant) and Breath for Life. If you require to step outside of the contract, the policies will be applied with consistency and neutrality.*

Please note that these policies are meant to be applied to everyone fairly and impartially if the terms of the contract are called into question or challenged.

I would like to pay for this course*

Yes

I accept that the purchase of this course will appear as Breath for Life Inc on your credit card statement and that the amount that will appear on your credit card will not be contested as a fraudulent charge (this also applies if you are registering someone else into this course).*

Yes

Credit Card

Card Details

Cardholder Name

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“First Aid & CPR Training in Edmonton and Area”

Advanced First Aid Registration Form

Step 1 of 3

CANCELLATION/RESCHEDULING POLICY