CARDIOPULMONARY RESUSCITATION (CPR) & AUTOMATED EXTERNAL DEFIBRILLATOR (AED) REGISTRATION FORM

www.canfitpro.com | 110-225 Select Ave., Toronto, ON, M1X 0B5 | info@canfitpro.com Local: 416-493-1756 | Toll Free: 1-800-667-5622 | Fax: 416-493-1756

Please print your name as you would like it to appear on your certificate. canfitpro ID: Miss Mr Mrs Ms Dr

Last Name First Name Middle Initial

Mailing Address Email – Mandatory

City Province Postal Code

( ) ( ) ( ) Home Phone Work Phone Cell Phone

Date of Birth (MM/DD/YYYY) - Mandatory Club or Business Title (fitness instructor, personal trainer)

Please register me for the canfitpro CPR & AED Course:

Course ID Course Location (City/Province) Name of PRO TRAINER Date

Course Fees

Member rates are valid for those who hold a current Professional Membership

with canfitpro

CPR CPR & AED

Total Early Bird More than three weeks

prior to the course.

RegularLess than three weeks

prior to the course.

Early BirdMore than three weeks

prior to the course.

Regular Less than three weeks

prior to the course.

CPR – A (Adult CPR)

Member $38 $43 $60 $65

Non-Member $47 $52 $69 $74

CPR - C (Adult, Child & Infant CPR)

Member $55 $60 $64 $69

Non-Member $64 $69 $73 $78

Professional Membership $98 New Membership $78 Renew Membership Gift certificate must be submitted by mail with registration form, no expired certificates will be accepted

* GST (Goods and Services Tax) applicable in Quebec, British Columbia, Manitoba, Alberta, Northwest Territories, Nunavut,and Saskatchewan. (Applied to location where course or exam is being held).**

Please note: Professional certification with canfitpro requires a current (less than one year old) Adult CPR in order to be valid. If you would like more information about canfitpro Professional certification or membership please visit www.canfitpro.com.

- Gift Certificate

SUBTOTAL

+ *GST at 5%or

+ **HST at ____%

TOTAL

Cheque/Money Order (cheque or money order must be enclosed and payable to ; no post-dated payments accepted) Mail: 110-225 Select Ave., Toronto ON, M1X 0B5 Fax: 416-493-1756 Email: info@canfitpro.com Visa/MasterCard Card number: Expiry:

Please check all boxes and provide signature below to acknowledge that you understand all cancellation and registration policies:

I have read, understand, and accept this agreement, the cancellation policy, and all disclaimers and I am aware that by signing this agreement I amassuming certain risks and waiving certain legal rights which I may have against the organizers.I understand, and agree, that due to timing issues the certification event that I am signing up for may be full and that I may need to alter mychoice, at no cost, in order to be in a program that is currently available.I understand, and agree, that my registration is not complete until the payment for the item(s) is successfully processed and I receive a completeconfirmation from . I agree that the information I have provided is correct and that any discrepancies, or incorrect information, will delay, or prohibit, me from being registered into the program that I have chosen.I provide permission to communicate with me about their products, services and sales offers via electronic formats

Signature: Date:

CVV:

Cardiopulmonary Resuscita�on (CPR) & Automated External Defibrillator (AED) Registra�oncanfitpro Registra�on, Cancella�on and Liability Policies

Assumption of Risks In regard to my preparation for and my participation in the canfitpro Certification Course and/or Exam (herein called the “Program”), including but not limited to the fitness activities and exercise held at the Program, I am aware: a) fitness activities and exercise and the participation in the Program

exposes participants to many risks and hazards, some of which areinherent in the very nature of the training required, the Program andfitness activities and exercise itself, others which result from human errorand negligence on the part of the persons involved in preparing,organizing and staging fitness and exercise activities;

b) as a result of the aforesaid risks and hazards, I as a participant may sufferserious personal injury, (even death), as well as property loss;

c) some of the aforesaid risks and hazards are foreseeable, but others arenot;

d) I nevertheless freely and voluntarily assume all the aforesaid risks andhazards, and the possibility of personal injury, death, property damage orloss, resulting therefrom and that, accordingly, my preparation for, andparticipation in, the aforesaid fitness activities and exercise and Programshall be entirely at my own risk; and

e) that I understand that the organizers, officers, directors, employees,independent contractors, agents, affiliated clubs, sponsors or volunteersdo not assume any responsibility whatsoever for my safety during thecourse of my preparation for, or participation in, the aforesaid fitnessactivities, exercise or Program.

f) The Organizers reserve the right to change or cancel any sessions orpresenters at their sole discretion.

Release of Liability, Waiver of Claims, And Indemnity Agreement I hereby acknowledge and agree, in consideration of being permitted to participant in the Program, as follows: 1. TO WAIVE ANY AND ALL CLAIMS, known or unknown, that I may have or

may in the future have against the Organizers.2. TO RELEASE THE ORGANIZERS from any and all liability for any and all

personal injuries, loss, damage, expense or injury including death that Imay suffer, or that my next of kin may suffer resulting from or arising outof my preparation for and participation in the Program DUE TO ANY CAUSEWHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT, ORBREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, ON THE PART OFTHE ORGANIZERS, AND ALSO INCLUDING THE FAILURE ON THE PART OFTHE ORGANIZERS TO SAFEGUARD OR PROTECT ME FROM THE RISKS,DANGERS AND HAZARDS OF FITNESS ACTIVITIES AND EXERCISE REFERREDTO ABOVE.

3. TO BE LIABLE AND TO HOLD HARMLESS AND INDEMNIFY THE ORGANIZERS>from any and all liability for any damage to property of, or personal injuryto, any third party, resulting from or arising out of my preparation for andparticipation in the Program.

4. The Organizers may videotape, audiotape and/or photograph me andretain the rights to use these items and may employ any or all of these forall commercial and non-commercial purposes without payment of any kindto me and without further notice to me or permission from me.

5. Each section, part, term and/or provision of this Agreement will beconsidered severable and fully-enforceable. In the event that any one ormore of the provisions contained herein shall, for any reason, be held tobe invalid, illegal or unenforceable in any respect, such invalidity,illegality or unenforceability shall not affect any other provisions of thisAgreement, but this Agreement shall be construed as if such invalid,illegal or unenforceable provisions had never been contained herein.

6. This Agreement shall be effective and binding upon my heirs, next of kin,executors, administrators, assigns and representatives, in the event of mydeath or incapacity.

7. This Agreement and any rights, duties and obligations as between theparties to this Agreement shall be governed by and interpreted solely inaccordance with the laws of Ontario, Canada. Any litigation involving theparties to this Agreement shall be brought solely within Ontario, Canadaand shall be within the exclusive jurisdiction of the Courts of the Ontario,Canada.

In entering into this Agreement, I am not relying upon any oral or written representations or statements made by the Organizers with the respect to the safety of fitness activities and exercise and the preparation for an the participation in the Program, other than what is set forth in this Agreement.

we are not able to reschedule, participatns may be eligible for refund ofcourse or exam fees, and membership (only within 30 days of purchase). Course materials are non-refundable.

Registration Deadline - For optimal success, canfitpro strongly advises registering approximately three weeks in advance of an event date to allow time to review the course and/or exam materials. To register for a certification course or exam, candidates are required to submit payment with their registration form. Registrations will not be processed without the correct payment. Registration Fees - Candidates who register a minimum of three weeks prior to the advertised course or exam start date qualify for the early bird registration fee for the course and/or the exam. Mailed registrations must be post marked at least three weeks prior to the advertised date to qualify for the early bird registration rate. Candidates who register less than three weeks prior to the advertised course or exam start date are required to pay the regular registration fee for the course and/or the exam. On-site registrations are not recommended as we cannot guarantee availability of space or course and exam materials without previous payment and notification. Once a registration is processed, discounts and/or promotional codes cannot be retroactively applied. Membership - Candidates who register at the non-member rate receive a one year Professional membership with canfitpro. As a canfitpro member I will automatically be included on repscanada, The Canadian Register of Exercise and Fitness Professionals. It will include my name, city, province and certification status (if applicable) and will not include street address, phone or email. For more information, including how to opt out, please visit www.repscanada.com. canfitpro membership fees are non-refundable. Your membership can be cancelled by giving us at least 30 days notice at infor@canfitpro.com. This allows you to provide the date on which you gave notice, one month in advance of the scheduled cancellation. Each member is responsible for the cancellation of his or her own membership. Cancellation Policy - If a Candidate has chosen not to attend or defer a course or exam, they may cancel or defer their registration providing a request for cancellation or deferral is received in writing, via email to info@canfitpro.com at least five days prior to the published course or exam start date. Cancellations or deferrals received 5-60 days prior to the course or exam date are subject to an Administration Fee of 15% (plus applicable taxes) of the total course or exam registration fee (excludes canfitpro membership and all course materials). Cancellations or deferrals received more than sixty days in advance of the course or exam will not be charged an administration fee. Cancellations or deferrals will not be accepted if notice is given less than five days prior to the start date of the course and/or exam. If the Candidate has ordered canfitpro materials (course manual, study guide, online course), a refund will not be issued for the materials. Transfers - If a candidate cannot attend a course or exam they may transfer the course or exam to another person at the original purchase price. Transfers are not applicable to canfitpro memberships. Transfers may only be completed by phone by calling canfitpro customer service at 1-800-667-5622. Full payment from the new candidate must be received prior to the original Candidate being refunded (minus the cost of canfitpro membership) the course or exam fee. Transfers must be completed prior to the start of the course or exam during canfitpro business hours. Course Materials & Shipping - Includes course manuals, study guides, key codes for online courses. The regular shipping period is approximately ten business days from the time canfitpro receives the registration. If you register less than ten business days in advance of the start date of the course and/or exam, you may not receive your materials prior to the start of the event. Express shipping is available at an additional fee and is approximately three to four business days from the time canfitpro receives the registration. Course materials are not eligible for refunds, credits or exchange. Unclaimed materials, and/or materials shipped to an incorrect address as provided by the candidate are subject to a $25 (+ Applicable Tax) Re-shipping Fee. Age - Anyone who wishes to register and participate in a canfitpro Certification Course you must be at least 16 years of age. Anyone who wishes to register and participate in a canfitpro Certification Exam you must be at least 18 years of age. PRO TRAINER Cancellations - canfitpro reserves the right to cancel a previously scheduled course or exam if minimal participation requirements are not met. Your PRO TRAINER will contact you should a course or exam be cancelled. We strongly advise you to confirm the status of your course or exam with your PRO TRAINER prior to attending. In the event that a course or exam is cancelled by the PRO TRAINER canfitpro will work with you to reschedule your coure or exam. In theevent that a course or exam is cancelled by the PRO TRAINER, canfitprowill work with you to reschedule your course or exam. In the event that

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the event that we are unable to reschedule, participants may be eligible