UCSB Department of Recreation Certification Interest Form

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Thank you for your interest in taking a Department of Recreation certification course! UCSB offers multiple types of instruction including Adult and Pediatric CPR/AED/First Aid, lifeguarding certification, and training for babysitters. Please enter your contact information for more information regarding these programs.

Contact Dillen Corlett for more information: dcorlett@ucsb.edu

(By entering your contact information you agree to be contacted by the UCSB Department of Recreation, Associated Students Public Safety Commission, or other affiliated groups by phone or email. Your contact information will only be used in relation to the purpose of this survey)

Name *

Email
*

Phone

Which courses are you interested in taking?

Lay Responder (CPR/AED/First Aid)

Lifeguarding and CPR/AED/First Aid for Professional Rescuers

Babysitters Training

Other:

Why are you interested in being certified?

Personal Preparedness

Professional/Organization Requirement or Relevance

Other:

We offer discounted rates for groups of 10-20 (see photo). Are you part of a group that might be interested in trainings? (If so, please indicate the organization and any contact information)

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