PLEASE Read Before Registering:
-All students (NOT including 4th Year WFU Med Students) need to complete sections 1, 2, and 4
-4th Year WFU Med Students need to complete sections 1 and 3 only


BLS, ACLS, and PALS E-Learning Skills Check-Off Registration Form

 
Section 1 (ALL Students)
 
First Name  
Middle Initial  
Last Name  
Credentials (RN, EMT-P, MD, etc)  
Phone Number  
E-Mail  
   
   
Are you an NCBH or WFHS/School of Medicine Employee?

 

 
               
   
WFHS employees: You must send a signed and completed authorization form toLife Support Education in order to receive an online access code. This form must be completed by the administrative person in your area and allows us to bill your department for the course. This is a requirement to attend class. You can find this form on the Life Support Education website under "FORMS."
   
IF you are an NCBH or WFHS Employee:
Employee ID (Required)
 
   
Will you need an online access code, or have you already completed the online portion?
(BLS for HealthCare Providers Online Part 1, HeartCode ACLS Part 1, or HeartCode PALS Part 1)
 
               
   
Section 2 (All Students, EXCEPT for 4th Year WFU Med Students)
NOTE: 4th Year WFU Med Students do NOT need to complete this section
   
Which skills check-off do you need?
Check ALL that apply!
 
         
   

Please choose a date to attend your preferred classes
(If attending more than one, choose a date for each class)

NOTE: You can sign up for a BLS, ACLS, and PALS check-off in the same day if desired.  

   
BLS  
   
ACLS (In order to attend ACLS, you must be current in BLS)  
   
PALS (In order to attend PALS, you must be current in BLS)  
   
Section 3 (4th Year Med Students ONLY)
   
April 15, 2014 (Med Student BLS and ACLS E-Learning Skills Check Off)
PLEASE NOTE: You must complete BOTH BLS AND ACLS in order to attend this check-off.
 

 
Section 4 (All Students, EXCEPT for 4th Year WFU Med Students)
   
By choosing "yes," I understand that payment will be required BEFORE any online access codes can be issued. Once payment is received, we will email your code to you. If I am paying by an authorization form (WFHS employees), I must contact Life Support Education at 716-2888 to request that the code to be emailed. Once this code is emailed, your department will be billed for the cost of this course regardless of whether you attend class or not.
   
   
To make payment arrangements, please call 336-716-2888.  
Comments/Concerns  

 

Quick Reference

Life Support Education
Tiffany Loggins
For BLS, ACLS, & ITLS Questions

Phone 336-716-2800
Fax 336-716-5927

Contact Tiffany
tloggins@wakehealth.edu

Jill Pettit
For PALS, NRP, ENPC, TNCC, PITLS, & E-Learning Questions

Phone 336-716-2888
Fax 336-716-5927

Contact Jill
jpettit@wakehealth.edu

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Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.