September 10 | PREP Registration Please enable JavaScript in your browser to complete this form. – Step 1 of 4PREP Registration – September 10 Course Date: Tuesday, September 10 2024 Time: 7:15 – 8:15 pm Location: Mohawk College, (135 Fennell Ave W. Hamilton, ON), Room C143. For a map of campus and directions, click here. PREP Practice – $50.00 + HST ($56.50) Please complete these forms and bring them with you to the PARE Test/Practice. Get Active Questionnaire (PDF) Informed Consent for PREP (PDF) Contact InformationName *FirstLastEmail *EmailConfirm EmailPhone *NextPersonal Health InformationPlease answer the following questions as accurately as possible. Gender *Please select one of the followingMaleFemaleOtherAge *Do you need a MEDICAL NOTE from your doctor? Are you OVER 40 year of age? If so, then YES you need a MEIDCAL NOTE regardless of your fitness level. Height (ft. or cm) *Weight (lbs. or kg) *Have you completed the PREP before? *YesNoHave you completed the shuttle run before? *YesNoWhat level did you make it to? *PreviousNextEmergency ContactPlease provide the name and contact information of someone we can call incase of an emergency.Name *FirstLastRelationship *Phone *PreviousNextPlease select your payment option. *Online credit card – $56.50Etransfer – $56.50Payment *Etransfer Payment Information NOTE: Registration is not confirmed until payment is made. Please e-transfer payment to emergencyservicestraining.info@gmail.com. Include your full name and testing date in the comments. Please complete these forms and bring them with you to the PARE Test/Practice. Get Active Questionnaire (PDF) Informed Consent for PREP (PDF) PreviousSubmit Please contact emergencyservicestraining.info@gmail.com if you have any questions.
