American Red Cross

Health & Safety

First Aid, CPR and AED Programs

Course Registration Form

Wayne Pike Chapter
Together, We Can Save A Life!

Download and print registration form. Please submit by US mail or in person at least two full workdays prior to the program start date.  All courses are limited in size.  Participants are accepted on a first registered, first enrolled basis.  No registrations may be accepted without payment in full.  The American Red Cross reserves the right to cancel any session with less than six (6) participants or in the event of unsafe weather conditions.

Date 
Name (First, MI, Last)
Address
Daytime Phone Evening Phone
Email
Course(s) _________ Adult CPR $30
_________ Adult CPR with AED $35
  _________ Infant/ Child CPR $30 ($10 with any above selection)
_________ First Aid Basics $25 ($10 with any above selection)
Time 
Location  
Prerequisites    
Amount Enclosed $__________________
Checks payable to the American Red Cross
 
Return form with payment to: American Red Cross
1111 Main Street
Honesdale, PA 18431

Master Card/Visa accepted - call 253-2310 to register by phone

Weather Cancellations will be announced on

WARM Radio (590AM), Magic 93 (92.9FM), and SUNNY 105 (105.3FM)

 

Office Use Only:
Payment Method
Cash Check # Credit Card
Invoice #
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