WILLIAMSON COUNTY AMERICAN RED CROSS CLASS REGISTRATION FORM

Date: _____________

Participant’s Name: _________________________________________________________________

Participant’s E-mail: ________________________________________________________________

COMPLETE THIS SECTION ONLY IF REGISTERING FOR BABYSITTING TRAINING

Participant’s Age: _____   Participant Parent’s Name: _______________________________________

Daytime Phone: ______________________ Home Phone: ___________________

Address: ____________________________________________________________________

____________________________________________________________________________

Register for the following class(es):

            Course                                                                         Date                                  Cost

  Adult CPR                                                               ________________               __________

     Check here to add AED training to Adult CPR                                                               __________

  Infant/Child                                                               ________________               __________

  First Aid                                                                   ________________               __________

  Babysitter Training                                                    ________________               __________

  Other (fill in course name)_______________           ________________               __________

Method of payment ($25 minimum for credit card transactions)

Check or cash________       Check #_______

Credit Card:  ________Visa __________Master Card      

Credit Card Number___________-____________-____________-__________

Expiration Date_________________________________