First Aid - First Aid Course Participant Form

Participant Info

Your Name*

First Last

Your Age*

Gender

Street Address*

City*

Postal Code*

Phone*

Email*

I understand that my e-certification and a recertification email (in 3 years) will be sent to my email.*

Yes

Get a recertification reminder email in about 3 years. We respect your privacy and will not rent or sell your information. You can be removed from the list at any time.

How did you hear about Right Reaction?*

Referral's Name

If other, please describe:

Course Info

Course Start Date

Course I'm Taking*

Standard First Aid & CPR/AED Blended (50% Online)(SFA)
Standard FIrst Aid & CPR/AED Recert (SFA-r)
Standard First Aid & CPR/AED Traditional (100% In-Class)(SFA)
Emergency FIrst Aid & CPR/AED (EFA)
CPR/AED
BLS

If other, please describe:

I'm Interested In:

Click the box and we'll email you details

Health Precautions

Right Reaction is committed to safeguarding the health and safety of participants in any course. For most people, the physical activity involved in a First Aid/CPR course should not pose a threat to your health. There are a small number of people who may find the physical activities in this course strenuous.

If you have any of the health conditions listed below, we recommend that you do not participate in the skills practice and demonstration involving physical activity until you have checked with your personal physician:

A history of heart attack / other heart conditions
Respiratory problems
Other physical disabilities
Are pregnant

If you are unsure if you should participate in any physical aspect of the course, please see the instructor before the course begins. Should you wish not to perform the physical skills, you cannot successfully complete the course and receive certification. Please talk to the instructor about acceptable modifications.

I have read and understand the Health Precautions*

Yes