American Red Cross - Central North Carolina Chapter
Organization: Date Rented:
Instructor: Rentals Due Back On:
Person Picking Up: Initial:
Email: Date Returned:
Phone Number: Initial:
Course Name:
Number Number ARC
Rented Item Cost Total Billing Code Returned Initials
Items may be rented for three (3) business days. Date of pickup is considered day one.
Adult Manikin # $10 per manikin manikinrent
Child Manikin # $10 per manikin manikinrent
Infant Manikin # $10 per manikin manikinrent
Faces Adult: $2 per face in excess
faces
Child: Infant: of 2:1 ratio
AED Trainer # $10 per pack AED Rental AP
Video-CPR/FA; Video-
DVD Rental # *$10 per DVD set aquatic; Video-BST
Bag Valve Mask $2 per mask Bag Valve
Babysitter Supplies Box
Pet Manikin Box $20 per set Pet FA Box Rental
Total Cost: Invoice #:
Policy Statement
1. If there are any problems returning this equipment by the time indicated on the form, or if there are any
other issues, please call 919-489-6541 x328.
2. The person or company renting this equipment is responsible for any damaged or missing
equipment and will be billed accordingly.
3. I understand that keeping equipment past the return date listed on the top of the form will result in
charge for re-rental of equipment for an additional three business days. If kept for more than
fifteen (15) business days, the customer agrees to purchase rented items at full retail value.
4. I understand that course records must be turned in when equipment is returned.
I have read, understand, and agree to the policies stated above:
Date:
When renting equipment, please give five business days notice of request.
Fax form to 919-489-4026 or email cnccdurham@usa.redcross.org
Administrative Support Fee $5 per student
Blended Learning Fee $10 per student
redcrossonlinetraining.org Fee $15 per student
*DVD rental cost will increase to $25 per rental period starting July 1, 2009.
Rev. Feb 2009
American Red Cross - Central North Carolina Chapter
Material Purchase Form
Organization:
Purchaser:
Billing Information:
Phone Number:
Email Address:
Disposable Training Materials
Item Quantity Cost Total Billing Code
CPR/FA Combined Training Kit $2.00 FA Train kits
CPR Training Kit $1.00 CPR train kit
Manikin Face Shields box/50 $15.00 Face Shields Box
Gloves, box/100 $10.00 gloves
"I Learned How to Save a Life Today" stickers (roll/500) $20.00 stickers
Subtotal
Manuals (Student and Instructor) and DVDs
Lay Responder First Aid and CPR/AED
Item Quantity Cost Total Billing Code
Adult CPR/AED Skills Card $7.25 656691
Child/Infant CPR/AED Skills Card $7.25 656695
First Aid Skills Card $7.25 656692
Schools & Community (CPR/AED/First Aid) $16.00 652145
Workplace Workbook (CPR/AED/First Aid) $2.50 656694
Instructor's Manual CPR/AED/First Aid for Lay Responder $24.00 656693
CPR/AED First Aid for Schools and Community DVD $165.00 652146
CPR/AED First Aid for Workplace DVD $175.00 656690
Subtotal
Academic/Professional Series
Item Quantity Cost Total Billing Code
Bloodborne Pathogens book $2.00 655107
CPR/AED for the Professional Rescuer book $13.00 652162
Oxygen Administration book $2.00 652056
Responding to Emergencies book $32.00 656136
Sports Safety Training book $13.00 655535
Instructor's Manual CPR/AED for Professional Rescuer $24.00 652161
Instructor's Manual Responding to Emergencies $28.00 656137
Instructor's Manual Sports Safety Training $16.00 655544
CPR/AED for the Professional Rescuer DVD $100.00 652160
Responding To Emergencies DVD $199.00 656134
Sports Safety Training DVD $110.00 655545
Subtotal
Page 2 of 6 Rev. Mar, 2009
Swimming and Water Safety
Item Quantity Cost Total Billing Code
Swimming and Water Safety Manual $26.00 651314
Water Safety handbook $4.50 651306
Raffy Learns to Swim $2.00 651317
Waddles in the Deep $2.00 651318
Swimming and Water Safety Stroke Posters (set/7) $35.00 651324
Water Safety Instructor's Manual $23.00 651313
Water Safety Instructor Kit $52.00 651312
Swimming and Water Safety Program DVD Set $160.00 651321
Swimming and Diving Skills DVD $95.00 651316
Longfellow's Whales Tales K-6 Educational Packet $18.00 651315
Longfellow's Whales Tales Stickers (pkg/5 sheets) $10.00 651323
Longfellow's Whales Tales DVD $40.00 651319
Subtotal
Lifeguarding
Item Quantity Cost Total Billing Code
GuardStart Manual $9.00 655714
Lifeguard Manual $35.00 655731
Lifeguard Management $27.00 654148
GuardStart Leader's CD-ROM $22.00 655715
Instructor's Kit Lifeguarding $68.00 655733
Instructor's Manual Lifeguarding $33.00 655730
Lifeguard DVD $290.00 655732
Subtotal
Caregiving
Item Quantity Cost Total Billing Code
Babysitting Manual $15.00 655633
Instructor's Manual Babysitter Training $24.00 655632
Instructor Kit Babysitter Training $45.00 655638
Babysitter Training DVD $125.00 655630
Subtotal
Spanish Lay Responder
Item Quantity Cost Total Billing Code
Spanish Schools & Community Manual $15.00 652147
Spanish Workplace Workbook $1.35 656643
Spanish Adult CPR/AED Skills Card $7.25 656641
Spanish Child/Infant CPR Skills Card $7.25 656642
Spanish First Aid Skills Card $7.25 656645
Spanish Instructor's Manual (includes DVD) $24.00 656644
Subtotal
Injury Control and Safety Series
Item Quantity Cost Total Billing Code
Cat First Aid $17.00 657781
Dog First Aid $17.00 657780
Back Injury Prevention $1.75 656711
Ergonomics $1.75 656712
Managing Stress $1.75 656714
Slips, Trips, and Falls $1.75 656713
Workplace Violence Awareness $1.75 656716
Your Heart Matters $1.75 656715
Subtotal
Page 3 of 6 Rev. Mar, 2009
Reusable Training Materials
AED Trainer and Supplies
Item Quantity Cost Total Billing Code
AED Trainer six pack $260.00 AED Trainer 6pk
AED Trainer single $50.00 AED Trainer 1
AED Trainer six replacement pads $20.00 321254
Subtotal
Adult Manikin and Supplies
Item Quantity Cost Total Billing Code
Adult Manikin Little Anne - one $189.00 020021
Adult Manikin Little Anne - four pack $704.00 020023
Adult Manikin airway - one $2.50 lung
Adult Manikin Little Anne airways case of 24 $55.00 20300
Adult Manikin Little Anne airways case of 96 $207.00 20301
Adult Manikin Little Anne manikin faces pack of 6 $50.00 152004
Subtotal
Child Manikin and Supplies
Item Quantity Cost Total Billing Code
Child Manikin Little Junior - one $170.00 002101
Child Manikin Little Junior - four pack $617.00 002301
Child Manikin airway - one $2.50 lung
Child Manikin Little Junior airways case of 25 $53.00 183210
Child Manikin Little Junior airways case of 100 $196.00 183211
Child Manikin Little Junior manikin faces pack of 6 $50.00 183010
Subtotal
Infant Manikin and Supplies
Item Quantity Cost Total Billing Code
Infant Manikin Baby Anne - one $95.00 050001
Infant Manikin Baby Anne - four pack $352.00 050011
Infant Manikin airway - one $2.50 lung
Infant Manikin Baby Anne airways case of 24 $18.00 050100
Infant Manikin Baby Anne manikin faces pack of 6 $50.00 050200
Subtotal
Merchandise
Item Quantity Cost Total Billing Code
Pocket Mask $10.00 Pocket Mask
CPR keychain $8.00 keychain CPR
First Aid keychain $2.00 FA keychain
Emergency Action Steps Wallet Card (25/pack, English or
Spanish) $2.50 656705
Posters - choking or CPR $2.00 poster
Subtotal
Books and CPR/First Aid training kits may be ordered Total
directly from the manufacturer at shopstaywell.com
Invoice
Manikins and manikin supplies may be purchased directly at hslt.net
Page 4 of 6 Rev. Mar, 2009
Authorized Provider Rental Fees
Effective March, 2009
Charge Fee Description
The Authorized Provider program support fee
encompasses the program support that the Red
Administrative Support Fee $5.00 Per Student
Cross chapter provides through its Authorized
Provider program.
The manikin fee covers the use of a manikin for
every two students in the course, two faces per
manikin, and one lung per manikin. Faces in
Manikin Rental $10.00 Per Manikin
excess of 2:1 ratio are charged at an additional fee
of $2.00 per face. Manikins may be rented for
three business days.
The AED trainer fee covers the use of one to six
AED trainers for three business days. This
$10.00 Per Pack
AED Trainer Rental includes use of batteries and adult and child
(up to six trainers)
training pads. Authorized providers may not rent
more than six AED trainers at one time.
The DVD Rental fee covers the use of the DVD for
DVD Rental $10.00 Per Set the course the approved instructor is teaching.
Rental is for a period of three business days.
Instructors are expected to provide one set of
books and CPR and/or First Aid training supplies
Manuals, books, skills cards,
Varies per student in each class. Authorized Providers
training kits, etc.
are not to library books unless they receive written
permission from the Chapter.
Basic Services Provided to Authorized Providers Benefits of This Service to the Customer
Issuance of American Red Cross course completion certificates Because Red Cross training is standardized and recognized by many national, state, and
local authorities, proof and validity of training can easily be provided to regulatory agencies.
Maintenance of instructor records There is a centralized record of an instructor’s course activity.
The American Red Cross verifies the status of instructors, ensuring that they meet a
Reauthorization of instructors
minimum competency level.
A record of activity is available if the authorized provider needs historic information about
Maintenance of course record for five years
courses it offered.
The most current standards of care are incorporated into the training materials utilized.
Authorized providers have access to—
Access to high quality course curriculum and materials Programs developed by the nation’s premier safety organization with the involvement of top-
level experts.
Reasonably priced and high quality materials.
Regular updates and information to instructors
Authorized provider instructors have the most up-to-date information with which to teach.
Authorized provider instructors have easy access to American Red Cross support staff when
Technical assistance to instructors
technical or programmatic questions arise.
Quality assurance program Authorized providers have an outside organization—the American Red Cross—ensuring the
quality of the training provided and that a minimum level of standards has been met.
Permission to use Red Cross name and emblem in promotion Authorized providers can leverage the American Red Cross brand and trusted name and
of Red Cross instructional programs reputation at little or no cost.
Provision of flyers, brochures, posters and other promotional Authorized providers have access to high quality promotional tools that reflect national
materials promotional materials and campaigns at little or no cost.
Access free online updates to new programs
Access to Instructor’s Corner at instructorscorner.org Access instructor information and receive monthly e-mails from national headquarters
Order training materials 24 hours a day, 7 days a week through shopstaywell.com