EmailMe Form - MVHSS Registration

Name *

First Last

Email *

Please provide the name of your employer, if applicable

Please indicate only for the Child Abuse or Communicable Diseases courses

Initial (6 Hour)

Renewal (3 hour)

Occupation

Select the Course you would like to attend *

Communicable Diseases

Child Abuse

AHA Pedi First Aid

CPR

AHA Healthcare Provider CPR

AHA Heartsaver First Aid

AHA ACLS

AHA PALS

Street Survival for LEO's

If wishing to attend multiple classes, you may indicate the additional dates and courses in the comments section below.

For ACLS and PALS classes, please indicate *initial or *renewal in comments section below.

Course Date

MM / DD / YYYY

Please select the course date you are interested in attending. If the course spans over more than one date, such as a 6 hour initial course, you need only select the date of the first class.

Additional Comments and Terms of Registration

By clicking "Submit" you confirm that you will attend the class you have signed up for. You must notify MVHSS of cancellation either by e-mail or by phone no later than 48 hours prior to the scheduled date of the class. If you fail to notify us of a cancellation and do not show up for the class, you or your center will be billed for your full portion of that class fee. If you cancel within the 48 hour time period, you may be billed a cancellation fee of $15.

By clicking submit, you confirm that you understand and agree to these terms and conditions. Thank you for your registration.

We look forwad to seeing you in the classroom.