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Pediatric International Trauma Life Support Registration Form

This one-day course is designed to teach all levels of EMS personnel including first responders, EMTs, paramedics, trauma nurses, emergency nurses, and emergency physicians the skills necessary to recognize mechanisms of injury, assess and perform critical interventions, then package and transport the injured infant or child. Pediatric ITLS uses principles of pre-hospital trauma care and refines them for specific use on infants and children. These same principles apply for children being transferred from a primary hospital to a tertiary care facility. 

ITLS Pediatric manual can be purchased in Life Support Education for $40.


Employees  No Fee (must purchase book $40) 

Outside Students      $90 (includes student manual)

*Refunds will not be given if you are unable to attend this course.  Please do not pay for a course unless you are prepared to attend on the date that you have scheduled. 



Reading the ITLS Pediatric text and completing the pretest for the course is required. It is highly recommended that students have previously completed an ITLS, PHTLS, or PALS course. Upon completing course registration requirements, Life Support Education staff will provide you with appropriate study materials.


Successful completion requires a score of at least 74% on the written evaluation as well as successful completion of the patient assessment testing stations. Basic personnel (MR & EMT) will take a basic written exam and will only perform the basic level skills in their testing stations. Advanced personnel will take an advanced level written exam and will perform at the advanced level in the testing stations. 


Are you an Employee?
If YES, are you an NCBH, WFUHS, Cornerstone, Community Physicians, Wilkes, or Travel Nurse?  
If NO, place of Employment?  
Date to Attend
Last Name  
First Name  
Middle Initial  
Employee ID  
Credentials (RN, EMT-P, MD, etc)  
City and State  
Zip Code  
Phone Number  
If an Employee, Manager's Name / Department  
Method of Payment

Outside Student  $90 (includes student manual)

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 in cash, please deliver in person to the Department of Life Support Education on the 3rd floor South Building. 

If paying by credit card, please call 336-716-2888 or stop by Life Support Education.  


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


3rd Floor South Building

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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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