Test Vanessa Form - United General District 304

Test Vanessa

CPR class registration

"*" indicates required fields

Parent's Name*

First Last

Parent's Email*

Parent's Phone*

Youth's Name*

First Last

Youth's Age*

This class is for Teens ages 12-18

Do you qualify for reduced pricing?

We offer a discounted price for low-income families receiving at least one of the benefits listed below.

Does your family receive any of the following benefits: Basic Food (SNAP), Free or reduced price school lunch, Apple Health, or WIC (Women, Infants & Children)?*

Yes, our household receives at least one of these benefits

No, our household does not receive these benefits

Which of the following benefits does your family receive? (Check all that apply)*

Basic Food (SNAP)

Free or reduced-price school lunch

Apple Health

WIC (Women, Infants & Children)

CPR Class (traditional full-length) - regular price*

Price:

CPR Class (traditional full-length)- reduced price*

The regular price of the class is $100, but you qualify for a discounted price of $80.

Price:

Payment

Payment for CPR classes is non-refundable. If you cannot attend the in-person class on your scheduled date, please contact Stephanie Morgareidge at Stephanie.Morgareidge@UnitedGeneral.org as soon as possible. You may be able to reschedule to a future class or transfer your spot to another person. For blended learning classes, a transfer is possible only if you have NOT yet logged into the Red Cross online training platform. In addition, the required online portion of the class must be completed before the in-person class by the same person attending the class.

Total amount due

Billing Address*

Street Address Address Line 2 City State ZIP Code

Credit Card*

Card Details

Cardholder Name

Phone

This field is for validation purposes and should be left unchanged.

Testing Form Vanessa Book Items

Name(Required)

First Last

Name of the Event

Pick up Date(Required)

Pick Up Time

:

Return Date(Required)

Return Time

:

Item to book

Use drop down menu to see more options.

Quantity

Product Name

Quantity

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List

Column 1

Column 2

Column 3

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Post Custom Field

Please let us know how many of each lunch choice we should order for your team
Lunches are not allocated by individual, but this will help us ensure we have enough of each option available. Please note that Swinomish Casino does not allow substitutions to these choices.