Registration Form: HeartCode Basic Life Support for Healthcare Professionals (CPR/AED)
Recognize life-threatening emergencies, provide CPR, use an AED + relieve choking safely.
Blended combination of self-directed eLearning followed by instructor-led hands-on session.

Online and in-person sessions require separate fees and registrations.

Certification by American Heart Associated is valid for 2 years upon successful completion.
Once both sessions are completed, participant will receive a digital course completion card.

ELIGIBILITY
Open to UTHealth Students, Rec Center Members, All Other TMC Institutions + UT System Alumni

DATES
Offered the 2nd Tuesday of Every Month:
September 13t(Minimum must be met by 9/9)
October 11th (Minimum must met by 10/7)
November 8th (Minimum must met by 11/4)
**New Date** December 20th (Minimum must met by 12/16)

TIMES
12:00 - 1:00PM (For up to 6 participants.)
1:15 - 2:15PM (If 12:00PM class is full.)
2:30 - 3:30PM (If 1:15PM class is full.)
Participants will be assigned a class time upon enrolling.
Registration prior to day of class is recommended!
Minimum # of participants must be met by the Friday prior to the class.

ENTRY FEE 
There are 2 separate registrations and fees.
Online Portion: $32.50 (Paid directly to the American Heart Association:)

Hands-On Session (Paid directly to the Recreation Center)
$20 - UTHealth Students
$25 - Current Rec Center Members
$30 - All Other Texas Medical Center Institutions or UT System Alumni

REGISTRATION
Step 1: Visit https://shopcpr.heart.org/heartcode-bls to purchase + complete online training portion.
Step 2. Complete this Registration Form and bring printed eLearning certificate to enroll for required hands-on session.  ***eLearning certificate must be submitted at time of hands-on registration registration.

QUESTIONS
Contact Corey Jefferson at 713-500-8427 or corey.jefferson@uth.tmc.edu

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Email *
First Name *
Last Name *
Sex *
Phone # *
Specify which TMC Institution or UT-System Alumni? *
Which Department or School? *
What is your classification? *
Which class will you be taking? *
Any questions?
ASSUMPTION OF RISK AND RELEASE WAIVER:  I have volunteered to participate in the HeartCode Basic Life Support for Healthcare Professionals  at The University of Texas Health Science Center at Houston (UTHealth) Recreation Center.  I realize that such exercise, in some circumstances, elicit certain complications such as abnormal blood pressure, dizziness or fainting, irregular heart rhythms and, in some instances, heart attack or stroke.  I accept the risks associated with such exercise and understand that I may cease participation at any time and for any reason, including feelings of fatigue or any other discomfort or concern.  I further understand that, in connection with participation in this activity, it is my responsibility to disclose all relevant information regarding my health status and any previous experiences of unusual responses, symptoms, complications or other issues due to physical effort.  I also understand the importance of my promptly reporting any concerns or discomfort I may experience with effort during exercise.  I hereby release and hold harmless UTHealth, The University of Texas System, and their regents, officers, employees and representatives from liability for injury or death or damage to property that may result from my participation in this activity.  I have read this form and understand the procedures and risks involved and consent to participating in the HeartCode Basic Life Support for Healthcare Professionals.  Any questions I have regarding these procedures have been answered to my satisfaction. *
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A copy of your responses will be emailed to the address you provided.
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