Health & Safety Courses
Registration Form

Please print this page. Then complete and mail this order form today.

Full Name____________________________________________

Address______________________________________________

City _____________________ ST________ ZIP_____________

Home Phone___________________

Business Phone___________________

First Choice Course: Name, Date, Class ID#

____________________________________________________________________

Second Choice Course: Name, Date, Class ID#

____________________________________________________________________

Course registration fee $___________

Course textbooks can be mailed for an additional charge of $5.00 excluding the CT Child Care books.

 		$___________
Total $___________

To register, please include a non-refundable check for payment in the correct amount, payable to: American Red Cross or call the appropriate office to pay by MasterCard or Visa.

Questions? Call (203) 787-6721

Mail to
American Red Cross, 703 Whitney Avenue, New Haven, CT  06511
or
American Red Cross, 144 South Main Street, Wallingford, CT  06492