Breath for Life Inc
“First Aid & CPR Training in Edmonton and Area”
breathforlifeinc@shaw.ca
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Emergency Medical Responder Registration Form
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Proof of a Current (within one year) Standard First Aid Level C Certificate is required as a prerequisite and must be current within a year of taking it. You must take your course through one of the following agencies: Canadian Red Cross, St. John's Ambulance, Heart and Stroke. No other provider certificates will be accepted. It is strongly recommended that you take the Standard First Aid Level C Course
Click Here
with Breath for Life.
I am interested in registering into the National Red Cross EMR Program
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Yes
I understand that this program does not qualify me for the ACP provincial registration exam
*
Yes, I understand
This course is primarily for First Responders including Fire Fighters, Law Enforcement and others who do not intend on seeking registration with the Alberta College of Paramedics.
Please Enter Your Birth Date
*
MM slash DD slash YYYY
Please upload your current (within three years) Standard First Aid Certificate
*
Accepted file types: jpg, gif, png, pdf), Max. file size: 12 MB.
You must have a current, Standard First Aid Certificate, within three years, to qualify for this course.
Choose Your EMR Course Date
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- Select Your Course Date -
March 2 to March 20 - 8AM: In-Class Sessions; 1:30PM Virtual Sessions - In-class Training: 4443-99St; Virtual Sessions: In the comfort of your home
I am confident that I have selected the correct date and course.
*
Yes
As a Digital Manual is available for free and is available as a link on your confirmation/receipt for downloading, the cost of a Hard Cover Textbook is $175.00 plus GST
The digital manual will serve my needs and I do not require a Hard Manual
I would like to purchase a Hard Copy Manual
Select how you would like to receive your course materials (Textbook)
*
Ship to an address ($45.00 charge)
I will pick it up at the Breath for Life office
I will receive the manual on the first day of the course
Shipping Address
Street Address
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Qatar
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Rwanda
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Saint Helena, Ascension and Tristan da Cunha
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Saint Lucia
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Samoa
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Senegal
Serbia
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Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
We will notify you when your Manual is available for pick up.
Registrant Full Name
*
First
Last
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Phone
*
Registrant's Email: Please enter the email that you want Breath for Life to use to create your Canadian Red Cross Account. This email will also be used to send you your receipt and any correspondence during the course. You are required to remember this email to access your Red Cross Account where your certificate will be populated upon successful completion of the course.
*
You must not change this email when your account has been created by the Breath for Life office. If you decide to change your email, Breath for Life will not be able to help you.
Red Cross Emergency Medical Responder|EMR Course
Price:
Course GST
Price:
Hard Copy Textbook
Price:
GST
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Shipping Cost for Manual
Price:
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CANCELLATION/RESCHEDULING POLICY
Please read the
Policies
governing this course. Breath for Life
commits to delivering the
course that you register into. Breath for Life thanks you for your patronage.
I have read and understand the policies.
*
Yes
I am the cardholder and am paying and registering into this course for myself.
*
Yes
No
If yes, please enter your name, in the box, as it appears on your credit/debit card.
*
I am the cardholder, and am paying for the registrant (someone other than myself) to attend this course.
*
Yes
No
If yes, please enter your name, in the box, as it appears on your credit card.
*
What is your relationship to the registrant: the person you are paying for to attend this course?
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I am using someone elses credit/debit card and have received permission and their consent to use their credit card.
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Yes
No
If yes, please enter the credit card holder's name in the box.
*
What is your relationship to the cardholder: the person who is allowing you to use their credit/debit card to pay and attend this course.
*
You do not qualify to take this course as your payment must be legitimate.
By entering your name in the space provided, representing the cardholder and/or the registrant or the registrant borrowing someone else’s credit card, you accept the terms and conditions of the policies around your registration into this course. By entering your name in the space provided you are entering into a contract with Breath for Life. As Breath for Life’s goal is to never cancel courses, which you as the registrant would expect when you pay for this course, if you require to step outside of the contract (eg.: reschedule and/or cancel, miss your course, are late, etc ), the terms and conditions of the policies which you agree to will be used to guide decision making, in a fair, consistent and neutral way.
*
First
Last
I would like to pay for this course.
*
Yes
I accept that the purchase of this course will appear as Breath for Life Inc on your credit card statement and that the amount that will appear on your credit card will not be contested as a fraudulent charge (this also applies if you are registering someone else into this course).
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Yes
Credit Card
*
CAPTCHA
You must complete the captcha and then press submit. When you press submit you will see a turning circle. This means that your payment is being processed. Please allow time for processing and do not exit out. Thank you.
Please be patient while your transaction is being processed. Do not exit until you receive a thank you notice. If you exit this registration early, because of impatience, and reregister into this course again thinking that this is the correct course of action which may result in a duplicate registration, a service fee of 25% will be charged to issue you a refund on any additional registrations that should not have occurred.