Emergency Medical Responder Registration Form

Step 1 of 4

As the pandemic is still among us, Breath for Life politely asks that you wear a mask during the delivery of your course.
I am interested in registering into the National Red Cross EMR Program*
- Yes
I understand that this program does not qualify me for the ACP provincial registration exam*
- Yes, I understand
This course is primarily for First Responders including Fire Fighters, Law Enforcement and others who do not intend on seeking registration with the Alberta College of Paramedics.

Please Enter Your Birth Date*
Month
Day
Year
Choose Your EMR Course Date*
I am confident that I have selected the correct date and course.*
- Yes

As a Digital Manual is available for free and is available as a link on your confirmation/receipt for downloading, the cost of a Hard Cover Textbook is extra.
- The digital manual will serve my needs and I do not require a Hard Manual
- I would like to purchase a Hard Copy Manual
Proof of a Current (within one year) Standard First Aid Level C Certificate is required as a prerequisite and must be current within a year of taking it. You must take your course through one of the following agencies: Canadian Red Cross, St. John's Ambulance, Heart and Stroke. No other provider certificates will be accepted. It is strongly recommended that you take the Standard First Aid Level C Course Click Here with Breath for Life.
Select how you would like to receive your course materials (Textbook)*
- Ship to an address ($35.00 charge)
- I will pick it up at the Breath for Life office
- I will receive the manual on the first day of the course
Please provide a date and time, during the business week when you would like to pick up your materials*

If you do not pick it up, it will be available for you on the first day of the course.

Registrant Full Name*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Registrant's Email: Please enter the email that you want Breath for Life to use to create your Canadian Red Cross Account. This email will also be used to send you your receipt and any correspondence during the course. You are required to remember this email to access your Red Cross Account where your certificate will be populated upon successful completion of the course.*

You must not change this email when your account has been created by the Breath for Life office. If you decide to change your email, Breath for Life will not be able to help you.
Red Cross Emergency Medical Responder|EMR Course ($975+GST)
Price:
Hard Copy Textbook ($150.00)
Price:
Shipping Cost for Manual ($35.00 + GST)
Price:
Total
$ 0.00 CAD
CANCELLATION/RESCHEDULING POLICY

Please read the Policies governing this course. Breath for Life Does Not Cancel courses that you commit to. Breath for Life would like to thank you for your patronage.
By entering your name in the space provided you acknowledge that you have read, understand and agree to the specified policies. I also understand and accept that the purchase of this course will appear as Breath for Life Inc on my credit card statement and that the amount that will appear on my credit card will not be contested as a fraudulent charge.*

By entering your name you are accepting the policies, terms and conditions of this purchase.
I would like to pay for this course.*
- Yes
Credit Card
Card Details
Cardholder Name
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Emergency Medical Responder Registration Form

Step 1 of 4

CANCELLATION/RESCHEDULING POLICY