Course Materials:
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cooper
Pre-course Information will be sent to you upon
receipt of your completed registration form and
verification of course availability. COURSE
Life support Training Center
REGISTRATION IS NOT CONFIRMED UNTll YOU HAVE RECEIVED
THE PRE-COURSE INFORMATION. If YOU do not receive
the pre-course information two weeks after
submittina your reaistration form, please contact
the Life Support Trainina Center.at 1856) 342-2009.
It is suggested that all participants read the NRP
Provider Manual prior to coming to the course.
The manual is available for purchase from the LSTC
for $45.00. It is also on reserve at the Cooper library
for your convenience. (The manual is included for
paying participants). Also available to help you
prepare for this course is an Emergency
Cardiovascular Care (ECC) handbook available
through the Life Support Training Center for an
additional $1 6.00.
1 Refund Policy:
Cooper Employees
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A non-refundable cancellation fee of $100.00 will
be charged to Cooper employees who cancel
2 weeks (14 days) prior to the date of the course.
A non-refundable "no-show" fee of $175.00 will be
charged to Cooper employees who do not show
for the course.
In addition, $75.00 will be deducted via payroll
deduction due to lateness and the need to
reschedule the course date.
1 Refund Policy:
Non-Cooper Employees
NRP
Neonatal
Resuscitation
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Program
Cancellation for NRP courses must take place
2 weeks (14 days) prior to the date of the course
for a tuition refund minus the cost of the provider
manual.
THEREWlll BE NO REFUNDS OR TRANSFERRING TO ANOTHER
COURSE FOR CANCELLATIONS WITHIN TWO WEEKS f 1 DAYS^
OF THE COURSE DATE.
Cooper University Hospital
Life Support Training Center
in conjunction with the
American Heart Association
New Jersey Affiliate
(please complete in full)
Name (please print)
Cooper Employee ID#
The Neonatal Resuscitation Program (NRP) is an
educational program designed to teach life support skills
to all healthcare providers that are present at the birth of
a baby. The NRP course is designed to give the
healthcare provider the basic knowledge to care for the
neonatal patient in cardiac arrest and to manage
resuscitation efforts in conditions that may lead to arrest.
This course will provide the skills necessary to resuscitate a
newborn and to work smoothly as a team with other
healthcare professionals. The intended audience for this
course includes pediatricians, emergency physicians,
nurses, paramedics, respiratory therapists. and other
healthcare professionalswho may be involved in the first
critical moments of a newborn infant's life.
CANCELLATION / NO SHOW
LATENESS / EXPIRED CARD AGREEMENT
NEONATAL RESUSCITATION PROGRAM
ALL course participants must complete
and sicin this agreement to complete registration.
Home Address
City
State
Zip Code
Professional Status
Social Security #
Employer Name
Department
Home Phone #
Work Phone #
Participant Name (Please print)
I do authorize Cooper University Hospital's "Life Support training
Center" to deduct from my paycheck the sum of $100.00 for
cancellation two weeks (14 days) prior to the course or $175.00
for "No Show" under the terms and conditions of the Payroll
Deduction Agreement for the Life Support Training Center with
Cooper University Hospital. I am also aware that a charge of
$75.00 will be deducted from my paycheck if I need to
reschedule due to arriving to the course late.
I further authorize Cooper University Hospital to deduct $100.00
via payroll deduction if my NRP completion card expires
before I attend the course.
Course Date Desired:
(Registration deadline is 30 days before course)
Tuition: $275.00
(Course is free to Cooper employees whose NRP
completion card is current the day of the course date)
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There are no refunds or transfers to another course date given
to paying participants if course cancellation is less than two
weeks (14 days) prior to the course date, or H course
admisslon Is denied due to lateness.
Date
Cooper Employee ID#:
Method of Pavment
Check (Payable to: LSTC-Life Support Training Center)
Credit Card -Visa I MastercardI American Express
Credit Card #
---- -
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Signature
Director /Manager's Name:
(Please Print Name)
Return completed registration form & tuition to:
Life Support Training Center
Cooper University Hospital
One Cooper Plaza, Dorrance 253
Camden, New Jersey 08103
Date Received
Date Registered
PCI/Book Sent
July 27
August 1 1
September 9
October 27
December 2
-- -
Director/Manager's Approval
(Required for All Cooper employees)
Exp. date
201 1 NRP Course Dates:
January 12
February 4
March 23
April 27
June 9
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Participant Signature
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Prerequisites:
Participants must possess a current American
Heart Association Basic Life Support for
Wealthcare Providers card. Copv of Current
AHA BLS card must be attached with this form,
if.course was not taken at Cooper University
Hospital.
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Director/Manager's Signature:
Course Location & Time:
3 Cooper Plaza, Suite 400
Camden, New Jersey 08103
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Cost CenterIDept #:
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For further information, please call:
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Shop:
LSTC
Total Charge:
Event:
Reason:
NRP Course
or e-mail the office at:
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