Citizen CPR Program Registration Form

Read The Instructions Carefully
The Orange County Fire Rescue Department offers free CPR classes to the general public in both English and Spanish. The class offered will be the American Heart Association’s Friends and Family course. This course is designed for people who wish to know what to do in the event of an emergency in their homes or neighborhoods. Participants ages 8 through 18 years old, must be accompanied by a parent or guardian during the course. Because we require a parent or guardian signature, minors must use this form (English and Spanish) to apply for the course. One registration form per participant. Please send the form via fax or mail. Space is limited and registration is available on a first come, first served basis.
Please complete the form, below.
Personal Information
Name:
Age:
Mail/Street Address:
City:
County:
State:
Zip:
Phone:
Fax:
Email:
Course Interest
Course Date:
Course Type:	Adult Child/Infant Both
Preferred Language:	English Spanish Other:
Other Information
Why are you interested in learning CPR?
* Please Note: CPR for Family and Friends is an orientation to CPR and is not a certifying or credentialing course. For certified courses please contact the American Heart Association www.cpr-ecc.org or American Red Cross www.redcross.org/where/where.html. To view course dates, see the Citizen CPR or call 407-836-9081.