Hearts4Kauai Registration Form

Contact First Name*

Contact Last Name*

Business Name

If applicable

Street Address Line 1*

Street Address Line 2

City*

State*

Zip*

Email*

Phone Number*

Individual/Group

Individual

Private Group

Community Class (Heartsaver/First Aid/AED)

Blended or In-Person Course

Select or enter value

Skills Check Type

Select or enter value

Instructor Led Course

Select

Number of Students

Online course completion certification*

In order to schedule your skills check, you must upload a .pdf of your "AHA Online Completion Certificate" here.

Drag and drop files here or

Comments

Enter any special requests or preferred dates

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