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Wyoming County American Red Cross
PO Box 386
455 RT 6 E.
Tunkhannock Pa 18657
Phone: 570-836-2626
E-Mail: Wyocoarc@usa.redcross.org
Website: www.wyocoarc.org

HEALTH AND SAFETY COURSE Onsite class Registration Form.
Community/Workplace - REGISTRATION FORM as of October 31, 2009

            Name:

            Address:

            City,State zip:

            Phone:

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Onsite class Registration Form.

Adult CPR/AED $35.00________  Recertification  $30.00________ Date___________________
Child & Infant CPR $35.00_________   Recertification $30.00__________ Date_________________
First Aid $30.00_______  Recertification $25.00___________Date________________
Professional Rescuer  $60.00__________Date____________
Baby Sitting  $40.00 _________________Date___________

COST OF CLASSES_________-(discount if applies)_____________=Total Amt. Due______________

Acceptable Payment methods: Check, Money Order, and Online Payment Total amount Enclosed_________________

***PLEASE DO NOT SEND CASH***

For Information regarding Group Discounts or other questions-please phone: 570-836-2626
Special classes for your groups can be arranged.


To be eligible for recertification course and pricing you must hold a current certification for the course you are registering for,
you must also let us know prior to registration where you received your certification and when.
Participants will receive all course materials when they arrive for class;
Please indicate any special needs or physical limitations you may have so that we can accommodate your needs during training. Only one participant per application/ photo copies are allowed.
When your payment is received you will be granted a place in the class, providing that space is still available, If no space
is available for the month you will have the option of participating in a course the following month.
In the event a class needs to be rescheduled, we will make every attempt to place you in an upcoming class with out lose of your entrance fee.
No refunds will be given with out 48 hours notice, transfer to another class will be allowed. If you have rescheduled/transferred a class
more than once, no refunds will be given (unless class rescheduling is due to Red Cross happenings) No refunds for unattended classes after 2months from original scheduled class date.