I am interested in becoming a Youth Leader (Babysitting) Instructor*
- Yes
Date of Birth (Must be 18 years of age or older)*
Month
Day
Year

Youth candidates that are 16-17 years old please contact the office for registration

I have read the Youth Leader Babysitting Process on the website and understand that I need to complete the steps to become a certified Youth Leader Instructor*
- Yes
- No
Your selection determined that you do not qualify to take this course. Please read over this page.
Do you qualify for Step #3 (Teaching Experience) exemption*
- No, but I will complete this step with Breath for Life
- No, but I will complete my Teaching Experience elsewhere
- Yes, I am a Current Red Cross (FA or WS) Instructor or Instructor Trainer
- Yes, I am a Educator (Elementary or Secondary level)
It is your responsibility to ensure that the individual, who you are selecting for your Teaching Experience, has a Teaching Experience Supervisor (TES) certification. You must send the TES certificate to Breathforlifeinc@shaw.ca for verification prior to your co-teach.
I have a current Standard First Aid/Level C CPR*
- Yes
- No
What is the expiry date of your Standard First Aid/Level C CPR?*
Month
Day
Year
You must complete a Standard First Aid Level C course to qualify for the Youth Leader Instructor Course.
Please Click Here to register for a Standard First Aid Course (A new window will open).
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What is your Instructor ID Number*
What is the expiry date of your instructor certificate*
Month
Day
Year

Registrant Full 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.
As there is an online assignment for this program I would like to have the materials:*
- 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.
Do you want your materials shipped to a different address?*
- Yes
- No
Shipping Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Youth Leader Course: Teaching Exemption ($125+GST)
Price:
Youth Leader requiring Teaching Experience ($175 + GST)
Price:
Shipping ($35+GST)
Price:
Total
$ 0.00 CAD
CANCELLATION/RESCHEDULING POLICY
1. The course you are paying for is Final Sale and not refundable.
Breath for Life Never Cancels Courses that you commit to. 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 want to proceed with my payment*
- 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
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.
Credit Card
Card Details
Cardholder Name
CAPTCHA
You must complete the captcha and then press submit. When you press submit you will see a turning circle. This means that your payment is being processed. Please allow time for processing and do not exit out. Thank you.

“First Aid & CPR Training in Edmonton and Area”

Youth Leader (Babysitting) Instructor Form

Step 1 of 3

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CANCELLATION/RESCHEDULING POLICY