Health and Safety Course Registration Form


Print this Page and mail to:

American Red Cross of Southeastern Connecticut

150 Eugene O’Neill Dr., New London, CT. 06320

Registration Information:

Registration is on a first come-first served basis. Class size is limited to ensure high quality of instruction. To register, please call for availability. Space will only be held after payment has been made. Payment can be done in person at the chapter or mailed to the Chapter. We highly recommend that the course book be picked up prior to class and read before the first class meeting.

COURSE FEES ARE NON-REFUNDABLE UNLESS THE COURSE IS CANCELLED OR RESCHEDULED BY THE RED CROSS. If an individual registrant calls five working days or more prior to the first session of the course, the course fee will be applied once to enrollment in a future course. Courses will be cancelled if less than six students register.

Exact location and directions will be mailed with the confirmation letter.


Name (Please print)________________________________________________________

Street Address____________________________________________________________

City, State and Zip Code____________________________________________________

Home Phone ________________________Work Phone___________________________

Course Choice #1_________________________________________________________

If course is full, Choice #2______________________________________________

Amount Enclosed: ________________________________________________________

** Remember proof of current certification required for review training.

If you wouldn’t mind, please fill out the following questions for our records. Thanks for supporting the American Red Cross.

Why are you taking this course? (i.e. work, pleasure)

If for work, whom do you work for?

How did you hear about us? (i.e. newspaper, boss, friends)

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Norwich Courses – American Ambulance, One American Way

Gales Ferry Courses – Dow Chemical, Route 12, Allyn Point Plant

Chapter Courses – 150 Eugene O’Neill Dr., New London (formerly Camera One)