MVFD CPR & Hepatitis Survey
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1. Do you wish to sign up for CPR/AED training?

Do you wish to sign up for CPR/AED training? Yes

If YES, Please enter your name:

2. Does any member of your immediate family age 16 or older wish to sign up for CPR/AED Training?

Does any member of your immediate family age 16 or older wish to sign up for CPR/AED Training? Yes

If YES; Please list names and ages.

3. Have you previously had a Hepatitis B Vaccine?

Have you previously had a Hepatitis B Vaccine? Yes

I Don't Know

If NO or I DON'T KNOW, please enter your name:

4. If you answered No for Question 3, would you like the vaccination?

If you answered No for Question 3, would you like the vaccination? Yes

No (Answering no will require a signed waiver indicating you declined)

If YES, please enter your name:

MVFD CPR & Hepatitis SurveyExit this survey