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Class Signup Form

TO SIGN UP:

    Please print out this page and mail it in along with your payment.

Check ONE Class Location Class Date Site
    [ ] SPARK Sat, 02/04/2012 - 8:30am - 2:30pm SPARK Center.[location-street_0], [field_class_site_nid_location-city_0].[location-city_0]
    [ ] Franklin Square Sat, 02/11/2012 - 8:30am - 2:30pm Franklin Square.[location-street_0], [field_class_site_nid_location-city_0].[location-city_0]
    [ ] Children's Services of Roxbury Sat, 02/18/2012 - 8:30am - 2:30pm Children's Services of Roxbury.[location-street_0], [field_class_site_nid_location-city_0].[location-city_0]
    [ ] CCRC Wed, 02/22/2012 - 6:30pm - 8:30pm CCRC.[location-street_0], [field_class_site_nid_location-city_0].[location-city_0]
    [ ] Barbara DeLeggee Wed, 02/29/2012 - 6:00pm - 8:00pm Barbara DeLeggee.[location-street_0], [field_class_site_nid_location-city_0].[location-city_0]
    [ ] CCRC Wed, 02/29/2012 - 6:30pm - 9:30pm CCRC.[location-street_0], [field_class_site_nid_location-city_0].[location-city_0]
    [ ] Rockwood Sat, 03/03/2012 - 8:30am - 2:30pm Rockwood.[location-street_0], [field_class_site_nid_location-city_0].[location-city_0]
    [ ] Nice Sat, 03/10/2012 - 8:30am - 2:30pm NICE.[location-street_0], [field_class_site_nid_location-city_0].[location-city_0]
    [ ] CCRC Wed, 03/21/2012 - 6:30pm - 8:30pm CCRC.[location-street_0], [field_class_site_nid_location-city_0].[location-city_0]
    [ ] Grove Hall Sat, 03/24/2012 - 8:30am - 2:30pm Grove Hall.[location-street_0], [field_class_site_nid_location-city_0].[location-city_0]
    [ ] CCRC Wed, 03/28/2012 - 6:30pm - 9:30pm CCRC.[location-street_0], [field_class_site_nid_location-city_0].[location-city_0]
    [ ] CCRC Sat, 04/21/2012 - 9:30am - 3:00pm CCRC.[location-street_0], [field_class_site_nid_location-city_0].[location-city_0]

Please select the class you wish to join and fill out the following:

Student Sign Up Information


(Please PRINT)
Full Name:
Address:
City, State ZIP:
Phone #:
 
E-Mail:

I need to enroll in the following:
Type: (circle one) Rate: (include payment)
CPR Only $35.00
First Aid Only $35.00
BOTH (CPR & First Aid) $60.00

Please send in payment along with your order.

NOTE:

  1. DO NOT BE LATE! Starting times for classes are definite. Late arrivals will NOT be allowed into the class.
  2. Please bring a pen
  3. Bring your own food. A Lunch-break will be taken for day-time classes, but lunch is NOT included in the class.
  4. Children are NOT allowed in the class.

Please mail this form along with your payment to:

Life Savers Training
PO Box 128
Chelmsford, MA 01824