First Aid/CPR  Course Registration
Complete this form on the day of your course in the presence of an instructor as agreement to participate.
Sign in to Google to save your progress. Learn more
What course are you taking? *
Required
Certifying Body *
Location *
Required
Your email *
Your Phone Number (mandatory for Red Cross) *
First AND Last Name *
Date of course *
MM
/
DD
/
YYYY
Instructor *
Required
FITNESS/MEDICAL-I understand that participation in a first aid  course involves various levels of physical activity and that I am fit and willing to participate. Any medical conditions that may impact my performance or participation have been discussed with the instructor and accommodations may be made to complete the course material. *
RESPECT- I understand and respect that participants are in attendance to learn and that a positive, respectful environment is important to learning. All those involved in the course have the right to privacy and respect during the course. Behaviour considered disrespectful in nature in relation to language, race, ethnicity, sexuality, bullying and inappropriate use of electronic devices cannot be tolerated and will be addressed appropriately including possible termination of your participation in the event or course. *
PHOTOS- I consent to the use of my image by Shockwave Medical Training or Shockwave Paddle Adventures (Shockwaves) for marketing or promotional material in print and/or electronic format. Material may appear on the internet or on social media. If used, the image will remain professional and related solely to the promotion of first aid  programs. *
WAIVER- I understand that participation in any first aid course involves certain risk of injury or illness. Activities may involve lifting/moving objects to and from the floor/ground, carrying items, performing tasks on the floor/ground, exposure to outdoor elements such as rain, wind, cold/heat. Outdoor courses include inherent risks specific to the task such as sprains/strains and other minor injuries may be experienced. I understand that minor injuries/illness may be expected as a normal part of the activity and I agree to hold Shockwave First Aid harmless in the event of injury or illness. *
NEWSLETTER- I would like to have Shockwaves quarterly newsletter sent to me at the email address below so I can keep up on new courses, interesting articles and cool photos. *
Is the participant underage? *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms