City CPR Centre Fax In Registration Form

Please print and complete this form. Fax to City CPR Centre at 416-531-7123 or mail to the address below.
Deadline for signup: 3 days prior to class time.

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First Name Last Name

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Street Address Apt/Unit

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City Prov Postal Code

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Home Phone Business Phone

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Course Name Date Fee

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Amount of Payment

___Visa ___MasterCard ___Cheque ___Money Order

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Card Number Expiry Date

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Signature

Please note the following points and sign below:

Students must be available for the entire scheduled class times
All refunds and returned cheques are subject to a $20.00 administration fee. If you will be unable to attend a course, please contact us a minimum of 72 hours in advance of the course in order to obtain a refund. After that point no refund will be issued, but the student will be allowed to transfer into another City CPR Centre course within one month of the original course date. After that, the student will be required to re-register and pay the full fee again.
Since the course does involve sharing of equipment, it is best to reschedule into another course if you are feelng unwell.
The student acknowledges that the course involves physical effort and agrees to inform the instructor of any injury or condition which could be aggravated by their participation in the course and that the City CPR Centre, its employees, directors, officers and agents will not be responsible or liable for any claim, demand, action, present or future damages, or any other losses or liabilites of any description whatsoever which may arise from or in any way be attributed to any illness or injuries which are sustained by me or aggravated while particiating in any course or activity.

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Signature Date