Breath for Life Inc
“First Aid & CPR Training in Edmonton and Area”
780-434-1368
breathforlifeinc@shaw.ca
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Emergency Medical Responder Registration Form
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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
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Yes
I understand that this program does not qualify me for the ACP provincial registration exam
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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
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Month
Day
Year
Choose Your EMR Course Date
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- Select Your Course Date -
Aug 29,Sept 1,6,7,14,15 (8AM - 1PM); Aug 30,31,Sept 2,8,9,12,13 (1PM-6PM) - In-class (8AM - 1PM); Virtual Sessions (1PM - 6PM) - Breath for Life’s Training Facility - 4443 - 99 St T6E 5B6 (Parking Instructions: )
I am confident that I have selected the correct date and course.
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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
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First
Last
Address
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Street Address
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
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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