Participant/Applicant Name

Credentials

License Number

Unique Identifier (Month/day of birth and last 4 digits of ssn)

Hospital Affiliation

Mailing Address (include street, town, state and zip)

Email Address

Special Needs

BLS Class / Located in C & Sim Lab / Cost $45 BLS Class / Located in C & Sim Lab / Cost $45Contact ji.knight@nvrh.org for class times, $45

BLS Skills Check / Located in C & Sim Lab / Cost $25 BLS Skills Check / Located in C & Sim Lab / Cost $254/28/2021 from 5 pm to 6 pm, $255/28/2021 from 5 pm to 6 pm, $256/25/2021 from 5 pm to 6 pm, $257/26/2021 from 5 pm to 6 pm, $258/31/2021 from 5 pm to 6 pm, $259/29/2021 from 5 pm to 6 pm, $2510/28/2021 from 5 pm to 6 pm, $2511/29/2021 from 5 pm to 6 pm, $2512/28/2021 from 5 pm to 6 pm, $25

ACLS New Certification / Located in the C & Sim Lab / Cost $145 ACLS New Certification / Located in the C & Sim Lab / Cost $1455/6/2021 - 5/7/2021 from 8 am to 3 pm, $1458/5/2021 - 8/6/2021 from 8 am to 3 pm, $14511/4/2021 - 11/5/2021 from 8 am to 3 pm, $145

ACLS Recertification / Located in C & Sim Lab / Cost $45 ACLS Recertification / Located in C & Sim Lab / Cost $453/31/2021 from 8 am to Noon, $454/28/2021 from 1 pm to 5 pm, $455/28/2021 from 8 am to Noon, $456/25/2021 from 1 pm to 5 pm, $457/26/2021 from 8 am to Noon, $458/31/2021 from 1 pm to 5 pm, $459/29/2021 from 8 am to Noon, $4510/28/2021 from 1 pm to 5 pm, $4511/29/2021 from 8 am to Noon, $4512/28/2021 from 1 pm to 5 pm, $45

ACLS Skills Practice / Located in C & Sim Lab / $20 ACLS Skills Practice / Located in C & Sim Lab / $203/31/2021 from 8 am to Noon, $204/28/2021 from 1 pm to 5 pm, $205/28/2021 from 8 am to Noon, $206/25/2021 from 1 pm to 5 pm, $207/26/2021 from 8 am to Noon, $208/31/2021 from 1 pm to 5 pm, $209/29/2021 from 8 am to Noon, $2010/28/2021 from 1 pm to 5 pm, $2011/29/2021 from 8 am to Noon, $2012/28/2021 from 1 pm to 5 pm, $20

Heartsaver CPR/AED/First Aid / Located in C and Sim Lab / Cost $35 Heartsaver CPR/AED/First Aid / Located in C and Sim Lab / Cost $35Contact ji.knight@nvrh.org for class times, $35

Heartsaver Pediatric CPR/AED/First Aid / Located in C & Sim Lab / Cost $50 Heartsaver Pediatric CPR/AED/First Aid / Located in C & Sim Lab / Cost $50Contact ji.knight@nvrh.org for class times, $50

PALS New Certification / Located in C & Sim Lab / Cost $155 PALS New Certification / Located in C & Sim Lab / Cost $155 6/3/2021 - 6/4/2021 from 8 am to 3 pm, $1559/7/2021 - 9/8/2021 from 8 am to 3 pm, $15512/2/2021 - 12/3/2021 from 8 am to 3 pm, $155

PALS Recertification / Located in C & Sim Lab / Cost $50 PALS Recertification / Located in C & Sim Lab / Cost $503/31/2021 from 1 pm to 5 pm, $504/28/2021 from 8 am to Noon, $505/28/2021 from 1 pm to 5 pm, $506/25/2021 from 8 am to Noon, $507/26/2021 from 1 pm to 5 pm, $508/31/2021 from 8 am to Noon, $509/29/2021 from 1 pm to 5 pm, $5010/28/2021 from 8 am to Noon, $5011/29/2021 from 1 pm to 5 pm, $5012/28/2021 from 8 am to Noon, $50

PALS Skills Practice / Located in C & Sim Lab / Cost $20 PALS Skills Practice / Located in C & Sim Lab / Cost $203/31/2021 from 1 pm to 5 pm, $204/28/2021 from 8 am to Noon, $205/28/2021 from 1 pm to 5 pm, $206/25/2021 from 8 am to Noon, $207/26/2021 from 1 pm to 5 pm, $208/31/2021 from 8 am to Noon, $209/29/2021 from 1 pm to 5 pm, $2010/28/2021 from 8 am to Noon, $2011/29/2021 from 1 pm to 5 pm, $2012/28/2021 from 8 am to Noon, $20

ACLS/PALS Skills Practice Combo / Located in C & Sim Lab / Cost $30 ACLS/PALS Skills Practice Combo / Located in C & Sim Lab / Cost $30ACLS/PALS Skills Practice Combo (both sessions), $30