Helping you save lives… Every step of the way!

Course Registration Form

This course registration form is only for existing customers who have been approved for direct billing. If you are not sure if your organization has been approved, please contact your manager or administrator.

A copy of this request will go directly to the email address you listed in the “E-mail of authorizing person from organization” information box.

Visit our Course Calendar page for dates, times and locations of available courses.

You can find our available course dates & locations by clicking on the Course Calendar page link in the top navigation bar.
*If you choose the BLS (No ACLS/PALS) option, you will be required to complete the HeartCode BLS online course and then complete a skills testing session on the day of the course. You will receive a course key via your email (usually within 24 hours), along with instructions on how to access the online course.
If you choose to add BLS to ACLS/PALS, you will be asked to demonstrate BLS skils (adult, child, infant) and take a 20 question written test on the day of the course (after ACLS/PALS). No online BLS course is required.
Every participant is required to have a current Provider Manual on the day of the course.
You are required to complete the online ACLS or PALS pre-assessment with a minimum score of 70% and bring the completion certificate to the class for entrance. Go to www.heart.org/eccstudent and use either acls15 or pals15 as the key to access.

Registrant Information

Organization responsible for payment

After you submit this information, your authorizing person will automatically be sent a copy of this registration to the authorizing person email. The authorizing person must reply to this email with approval before you are considered registered. No course material will be sent until authorization has been received.
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