Complete this form to request an appointment for the AHA PALS Instructor Class.

DO NOT SUBMIT THIS FORM IF YOU ARE NOT READY TO SCHEDULE AND PAY FOR YOUR CLASS!

PALS Instructor Request Form

Name(Required)
Email(Required)
Address(Required)
Accepted file types: jpg, pdf, png, Max. file size: 32 MB.
You must have either taken your last PALS class at our facility in Longwood OR you must have been certified for at least 1 year.
I confirm that I am at least 18 years old.(Required)
I understand I will be required to align with Mid-Florida CPR as my Primary Training Center.(Required)
I understand that my alignment with your Training Center does not represent affiliation as an employee, independent contractor, partner, licensee, or franchisee, and I am responsible for the maintenance/purchase of all training equipment.(Required)
I understand that all fees paid for the instructor course are NON-REFUNDABLE.(Required)
Yes, I understand that all fees paid for the instructor course are NON-REFUNDABLE.
I confirm that by submitting this form, I am ready to complete the $575 payment today for the AHA PALS Instructor class. If you are not ready to complete the payment, do not submit this form. We do not reserve dates or hold seats for classes until they are paid for.(Required)