JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
RED CROSS CERTIFICATION COURSES
The Plattsburgh YMCA offers a variety of Red Cross Certifications courses. If you wish to sign up, please complete the form below to get registered. Payment information must be provided for a registration to be processed and to secure your spot.
A description of each course and any requirements can be found on our website at
www.plattsburghymca.org
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name of Participant
*
Your answer
Date of Birth
*
For Lifeguard Course - participants must be 15 years old by the end of the course
MM
/
DD
/
YYYY
Address
*
Your answer
Phone Number
*
Your answer
Which Course are you registering for?
*
Lifeguard Course (November 18-20)
Lifeguard Course (December 16-18)
Lifeguard Recertification Course (November 20)
Lifeguard Recertification Course (December 18)
Lifeguard Instructor Course (TBD)
CPR & Recertification Class (November 19)
CPR & Recertification Class (December 17)
Required
Credit Card Number
*
VISA or MASTERCARD ONLY
Your answer
Name on Card
*
Your answer
Expiration Date
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Plattsburgh YMCA.
Report Abuse
Forms
