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American Red Cross
First Aid – When Help is Delayed
ORIENTATION VERIFICATION
FORM
The purpose of this form is to
verify that American Red Cross Lay Responder First Aid and CPR/AED instructors wishing to teach
the First Aid – When Help is Delayed have received all
necessary information and oriented themselves to the new material.
Once you have completed your self-orientation, complete this form and
submit it to your American Red Cross unit of authorization. Upon
receipt of this completed and signed form, your unit will give you
authorization to teach this course.
Name___________________________________________________________________
Address_________________________________________________________________
Telephone: (Home)________________________(Cell)__________________________
Current instructor authorizations):
____Lay Responder FA & CPR/AED Instructor
____First Aid – Responding
to Emergencies
____Emergency Response
____Lifeguarding
I verify
that I have reviewed the following materials (check box when
appropriate):
____When Help is Delayed Participant Manual
____First Aid - When Help is Delayed Instructor Manual
____First Aid - When Help is Delayed Self-Study Guide
Signature_________________________________________Date___________________
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