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HeartCode BLS, ACLS, and PALS Skills Evaluation Registration Form

HeartCode BLS, ACLS, and PALS is a blended learning tool using dramatizations, eSims, animations, self-directed learning, and interactive activities to teach students Life Support knowledge and skills. After completing the online component, students will attend a structured Instructor led hands on skills session that focuses on meaningful skills practice, debriefing, team scenarios, discussions of local protocols and skills testing.

This interactive, scenario-based online format allows an alternative to traditional classroom learning.

a) Participants complete HeartCode BLS, ACLS, or PALS online component and receive a certificate of completion ( Part I). 

b) Participants attend a Instructor Led skills evaluation in Life Support Education (Part II) within 60 days of completing Part I. 

c) A Provider card is issued once Parts I & II are successfully completed. 

~~Beware of Scams! There are several websites that offer "online" courses. However, the American Heart Association DOES NOT recognize any E-Learning courses except the one they created. Please contact us for guidance before purchasing any online product.

**NOTE** Please know that e-Learning is not for everyone.  You must have excellent computer skills and a strong knowledge of course materials as well as the ability to navigate online in a video game like environment. The BLS online learning may take 3-5 hours to complete while ACLS and PALS may take 6-10 hours. (In order to attend ACLS or PALS, you must be current in BLS).


Outside Students: 

  • BLS   $50 (includes Course Key and Skills Evaluation)
  • ACLS / PALS   $170 (includes Course Key and Skills Evaluation)
  • BLS  $25 (Skills Evaluation Only)
  • ACLS / PALS $50 (Skills Evaluation Only)


No charge for course key and skills evaluation.  Once you receive the AHA course key, you must complete the entire course (online portion and skills evaluation) or you will be charged the cost of the class.

*Refunds will not be given if you are unable to attend this class. Please do not pay for a class unless you are prepared to attend the class date that you have scheduled. If unable to attend your scheduled date, we will gladly move you to a different day that will work with your schedule.


Are You an Employee?  
If YES, are you a NCBH, WFUHS, Cornerstone, Wilkes Regional,
Community Physicians, or Travel Nurse?
If NO, place of employment?   
Last Name   
First Name   
Middle Initial   
Credentials (RN, EMT-P, MD, etc)   
Employee ID   
City and State   
Phone Number   
E-Mail Address   
If an Employee, Manager's Name / Department   
Will you need an online access code, or have you already
 completed the online portion?


Select a Date of class or classes desired:

NOTE: You can sign up for a BLS, ACLS, and 

PALS check-off in the same day if desired.  

HeartCode BLS    
HeartCode ACLS )  
HeartCode PALS)  
Cost of Course and Method of Payment:

BLS   $50 (includes Course Key and Skills Evaluation)

ACLS / PALS   $170 (includes Course Key and Skills Evaluation)

BLS  $25 (Skills Evaluation Only)

ACLS / PALS $50 (Skills Evaluation Only)
If payment will be by check, please mail to: 

Department of Life Support Education 
Wake Forest Baptist Medical Center 
Medical Center Boulevard 
Winston-Salem, NC 27157  
If paying by credit card, please call 336-716-2800
 or stop by Life Support Education. 
By choosing "yes," I understand that payment will be required BEFORE any
online access codes can be issued. Once payment is received, we will email
your code to you. 

If I am an Employee and choose "yes", I agree to receive and online access
 code and attend class or be charged for the cost of this class.


Quick Reference

Life Support Education
Kathy Nelson

Phone 336-716-2005
Fax 336-716-5927

Contact Kathy

Mikell White
Education Systems Specialist

Phone 336-716-2800
Fax 336-716-5927

Contact Mikell


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Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.

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