CPR Certification Registration

CPR Certification Registration — Form Fields

This registration template includes 7 fields. Register for an American Heart Association CPR and first aid certification class. Free to customize and use on ZenBuild.

• Full Name (text, required)
• Email Address (email, required)
• Phone Number (text, required)
• Course Date (dropdown selection, required) — options: March 22 (Saturday, 9am–1pm), April 5 (Saturday, 9am–1pm), April 19 (Saturday, 9am–1pm)
• Certification Type (multiple choice, required) — options: CPR/AED Only, CPR/AED + First Aid, Pediatric CPR/AED
• Is this for professional/work requirements? (multiple choice, required) — options: Yes, No, personal
• Have you been CPR certified before? (multiple choice, required) — options: Yes, renewal, No, first time