Instructor Course Registration Form

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I am interested in taking the Skills Development Session with Breath for Life*
- Yes
- I have passed the Skills Session and want to Register into the online and in-class sessions
I have passed the Skills Session and am now ready to pay for the online and in-class sessions.*
- Yes
Please tell us why you would like to be a Red Cross Instructor*
Please Provide your Date of Birth*
MM
DD
YYYY

You must be 18 years of age or older to take this course.
I confirm that I have reviewed the Breath for Life web page and understand that the Instructor Course is a 5 step process (4 steps if you are a transfer student)*
- Yes
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I have a current Standard First Aid/CPR Level C*
- Yes
- No
Current means that you have taken the course within one year of the Skills Development Session date. Of importance is demonstrating skill proficiency. Your certificates will be reviewed on the Skill Development Session day.
You must be current, within one year to take this course. Please book into the Standard First Aid Renewal course: Click Here.
Please enter the expiry date of the current Certificate.*
MM
DD
YYYY

To attend this course your Standard First Aid must be current within one year of taking the Instructor Course. The expiry date on the card is not applicable to qualify for the Instructor Course.
Please let us know the agency where you took your Standard First Aid course. Include whether this is a Red Cross, St. John's, etc. provider.*
The pre-requisite for the Instructor's Course is a Standard First Aid/CPR Level C or BLS Provider. You do not qualify for this course unless you fulfill this requirement.
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I would like to attend the Skill Development Session on this date.*
Please select the first date. You will register into the second date when the have successfully completed the Skills Development Session.
I would like to register for the Online and In-class Sessions*
Please select the second set of dates.
Confirm Course Date*
I understand that the Skills Development Session is mandatory. I understand that I must be successful in this session to be able to move on to the online and in-class sessions of the First Aid/CPR instructor course.*
- Yes
I have passed the Skills Development Session and wish to proceed with this registration.*
- Yes

Registrant's Name*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Enter Email Confirm Email

This email will be used to send you the course information and receipt. Please also check your spam or junk folder if the email does not appear in your inbox.
Registrant's Email: You are required to provide an email that will be used to set up your Red Cross account (if you do not have an account). This email must be yours and not shared by anyone else and if different from the email above please enter it in the space provided.
Optional:
- Provide Your Company Details
Company Name*
Company Contact*
First Last
Company Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Company Phone Number*
Company Email*
Skill Development Session ($225 + GST)
Price: $ 236.25 CAD
Step 3 and 4: Online and In-class Sessions ($600 + GST)
Price: $ 630.00 CAD
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.
Payment - We accept the following Debit & Credit Cards*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
CANCELLATION/RESCHEDULING POLICY

Policies
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.
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By activating the CAPTCHA, you attest to having read and understand the extent of the policies. You must complete the CAPTCHA for your transaction to be processed. Please allow the transaction to process when you press submit. Do not leave this site until you will receive a notice that the transaction was successful. Thank you.
Please be patient while your transaction is being processed. Do not exit until you receive a thank you notice.

Instructor Course Registration Form

Step 1 of 3

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CANCELLATION/RESCHEDULING POLICY