1.Are you a parent, grandparent, or guardian of a child age 1 or under?

Parent

Grandparent

Guardian

2.Do you have a child age 1 or under?

Yes

No

I'm currently pregnant

3.Are you a resident of Ohio?

Yes

No

4.What day of the week works best for you to take this BLS (CPR) class?

Monday

Tuesday

Wednesday

Thursday

Friday

5.Would morning or afternoon time work better for you?

Morning

Afternoon

Both work

6.How many people from your family would be taking the course?

7.What is your name?

8.What is your phone number?