Register | Skilled Up Ohio, LLC

Please provide the following information:

Participant First Name

Participant Last Name

Birthday

Phone

Participant Email

Expectations

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

How did you hear about us?

Select an item ($)

Skill Up 101: Essential Skills for Life AM (9am-12pm) - $750

Skill Up 101: Essential Skills for Life PM (1pm-4pm) - $750

Red Cross Adult and Child First Aid CPR/AED - $117

What week works for you?

June 26-30th

July 24-28th

Red Cross Dates

July 8, 9am-2pm

July 12, 9am-2pm

Participant Age (First Day of Class)

Will the student be 18 on the first day of class? Check if YES.

Parent/Legal Guardian First & Last Name

Parent/Legal Guardian First & Last Name #2

Parent/Legal Guardian Phone

Parent/Legal Guardian Phone #2

Emergency Contact First & Last Name

Emergency Contact Phone

Emergency Contact Relation to Participant

*Emergency Contact is in addition to parent/legal guardian

Signature for Adult Waiver

Today's Date

Signature for Minor Waiver

Today's Date

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