SKILLS TEST REGISTRATION FORM (please fill out completely).          Questions? Call us at 973-341-4440
All skills tests are held at our Wayne, NJ facility. We are also available to hold skills test at your home or office.
You will receive further information once you've registered.
NOTE: This form is for ONLINE SKILLS TESTS ONLY. If you need to register for a regular class, click here.
Click to view map and directions.
All fields in bold are required.
First Name:
Last Name:
Address:
City: State: Zip Code:
Cell Phone Number: Please give your cell phone number if we need to contact you before the class.
E-Mail:
Re-enter Email:

Email will be the primary form of communication for class updates and reminders. We will not share your address with anyone.
This form is for ONLINE SKILLS TESTS ONLY. If you need to register for a regular class, click here.
Course:
Have you ever taken this or any CPR course in the past?
No Yes -
Please list your availability for your skills test,
Why you are taking this course, and any additional comments:

Best time to be reached:
How did you hear about or find us? (Google search, Facebook, word of mouth, flier (where was it posted?), etc.)

Before continuing, ensure all the information is filled out and correct.

TERMS:
Before submitting this form and registering for a class, you must agree to the following:
(1) show up at the scheduled date and time;
(2) pay the course fee due by the time of the class in the form of cash or check, or pay with credit/debit card on next page;
(3) you have read our cancellation policies;
(4) all of the information provided above is correct to the best of your knowledge.


I have read and agree to the above terms.
You must click the checkbox indicating you agree to the terms before you can submit your registration form.

Please enter the above words to prove you are human!
If you are asked to re-enter, you may need to uncheck and recheck the checkbox above.
Having trouble? Call us at 973-341-4440!

Training Courses:
Basic Life Support (BLS) for Healthcare Providers
CPR, AED, & First Aid
CPR/AED for Personal Trainers
Which class should I take?
Online Classes / Skills Tests
On-Site Training for Home or Office
Family & Friends CPR Anytime
CPR Equipment:
CPR Supplies
AEDs
First Aid Kits
Personal Life-Safety Monitoring Systems
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Directions
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FAQs
Information
Reviews & Testimonials
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Phase1CPR.com
American Heart Association Authorized Provider of CPR & ECC Courses
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