CODE BLUE CPR SERVICES | INSTRUCTOR ACKNOWLEDGMENT

AHA Training Site Instructor
Acknowledgment Agreement

Code Blue CPR Services | Training Center ID KY21007
Office / text: 629-932-0012 | codebluecprservices.com

This acknowledgment applies to instructors teaching authorized American Heart Association (AHA) courses through Code Blue CPR Services and their assigned Training Site. By signing, I accept the responsibilities below as a condition of teaching under this affiliation. This is a Training Center acknowledgment, not an official AHA form or an agreement with AHA itself.

1 Affiliation and authorization

I understand that instructor credentials, Training Center alignment, Training Site assignment, and system permissions serve different purposes. I may teach or issue course completion cards under this affiliation only when my credentials and required authorizations are current. Account registration, ordering eCards, or signing this form does not independently grant approval. I will not identify myself or my business as an AHA Training Center unless separately authorized to do so.

2 Applicable AHA and Training Center policies

I will review and follow the current applicable AHA United States Program Administration Manual, discipline-specific instructor manuals, official updates, and Training Center policies provided to me. Mandatory AHA requirements control if a local term conflicts. I understand that Code Blue administrative requirements are Training Center policies and are not automatically AHA requirements. I will seek clarification before teaching when requirements are unclear.

3 Instructor credentials and files

I will maintain current instructor credentials and any required provider credentials, complete required updates and course orientations before teaching affected courses, and meet applicable teaching, monitoring, and renewal requirements. I will provide requested applications, agreements, Instructor Essentials completion records, credentials, monitoring records, and update certificates. Identity or tax documents, when applicable to my role, must be submitted through the designated secure process.

I will promptly report an expired credential, suspension, alignment change, inability to meet requirements, or change to my contact information. I will not teach under an expired, suspended, or unauthorized status or permit another person to use my instructor identity. I will not add instructors, approve alignments, or create subordinate Training Sites unless expressly authorized.

4 Course delivery and student completion

I will use the current authorized curriculum, lesson plans, videos, manuals, and course materials and follow the required course format and instructor-to-student and equipment ratios. I will provide all required instruction, hands-on practice, skills evaluation, testing, and remediation. I will not shorten a course by omitting required activities or substitute unauthorized material for required AHA content.

I will verify course prerequisites and required online completion before the applicable skills session. Each student must meet the completion criteria for the specific course. Payment or attendance alone does not qualify a student for certification. I will document unsuccessful completion and remediation accurately and explain the student’s available next steps.

5 Equipment and training environment

I will ensure that the class has sufficient working equipment, including required manikins and feedback devices, AED trainers, ventilation equipment, and cleaning or protective supplies. I will follow current course equipment requirements and manufacturer cleaning instructions and provide a suitable, safe learning environment. I will report equipment problems and will not proceed with a course that cannot meet required standards.


Training Site Instructor Acknowledgment Agreement | Version 2026-09 | Page

CODE BLUE CPR SERVICES | INSTRUCTOR ACKNOWLEDGMENT

6 Class scheduling and student communication

I will enter accurate course dates, times, locations, formats, and instructor information in the designated system. I will communicate prerequisites, required materials, fees, cancellation terms, and completion requirements before class. I will promptly report schedule changes and cancellations to the appropriate Site Coordinator or Training Center and notify affected students. Any registration or scheduling tools provided to me must be used only within my assigned permissions.

7 Roster submission and course documentation

I will use Code Blue’s designated roster management system, including codebluecprservices.com when enabled for my account. I will enter class information and submit complete records within the deadlines in the Training Center’s current written roster policy. If the system is unavailable, I will promptly notify the Site Coordinator or Training Center, preserve the records securely, and follow the approved backup procedure.

My records will accurately identify the course, actual date and location, teaching instructors, students, and completion outcomes. I will submit the required roster and applicable skills checklists, exam results, course evaluations, online completion certificates, and remediation records. I will correct errors through the approved process and respond promptly to requests for missing documentation. I will not fabricate, backdate, alter, or conceal attendance, signatures, scores, course dates, or completion results.

8 eCard ordering and issuance

I will purchase, assign, and issue eCards only through approved channels and within my authorization. An order or payment for eCard inventory does not prove that a student completed a course. Before issuing a card, I will verify the student’s eligibility, required documentation, course type, completion date, and identifying information. I will meet applicable AHA issuance deadlines and promptly seek help if a documentation or system issue may prevent timely issuance.

I will not issue cards for courses I did not teach or that I am not specifically authorized to process. I will not issue cards for incomplete or fictitious training, share inventory outside authorized procedures, or allow another person to use my credentials. I will promptly report incorrect or duplicate cards and suspected misuse, and request correction through the approved process.

I understand that an advertised average processing time refers to delivery of ordered inventory to the applicable AHA Atlas account. It does not guarantee delivery for every order or authorize issuance to an ineligible student. I will review the disclosed price, payment, and refund or credit terms before purchasing. This acknowledgment does not set eCard prices or add an undisclosed fee, refund restriction, or forfeiture.

9 Exam security and protected materials

I will use the current authorized exam required for the specific course and administer it according to applicable instructions. I will protect exam access, answer keys, testing links, and copyrighted materials. I will not post protected exam content publicly, distribute answer keys to students, or reproduce or share protected materials without permission. Access to an exam does not authorize me to teach a discipline for which I lack approval.

10 Privacy and account access

I will use my own account, keep credentials confidential, and access only records necessary for my authorized duties. I will protect student and instructor information from unauthorized use or disclosure and use approved methods to transmit sensitive records. I will promptly report suspected account compromise, missing records, or accidental disclosure and cooperate with corrective steps. I will not use student information for unrelated purposes without appropriate permission.

I will preserve required training records for the applicable AHA and legal retention periods and follow the Training Center’s record custody instructions. I will not delete records subject to a complaint, audit, or preservation notice. Loss of affiliation or account access does not remove my duty to provide required records or protect confidential information.


Training Site Instructor Acknowledgment Agreement | Version 2026-09 | Page

CODE BLUE CPR SERVICES | INSTRUCTOR ACKNOWLEDGMENT

11 Monitoring and quality assurance

I will cooperate with authorized announced or unannounced course monitoring, record audits, student feedback reviews, and investigations by the Training Center and AHA as applicable. I will provide requested course information and reasonable access to relevant records, equipment, and teaching activities. I will complete assigned remediation or corrective action by the documented deadline and will not interfere with student feedback or retaliate against anyone raising a concern.

12 Professional conduct and affiliation statements

I will treat students, instructors, staff, and reviewers respectfully and maintain a professional learning environment free from harassment or discrimination. I will communicate complaints promptly through the designated Site Coordinator or Training Center. I will accurately describe my instructor status and use AHA names and marks only as permitted. I will not use Code Blue logos, letterhead, or endorsements without written permission or issue statements on behalf of the Training Center without authorization.

13 Restrictions and separation

I understand that noncompliance may result in corrective action, monitoring, restricted system or eCard access, suspension of teaching under this affiliation, or removal from the Training Site or Training Center, consistent with applicable policies and AHA procedures. Serious concerns, including suspected falsification, unauthorized teaching, or an AHA directive, may require immediate restrictions. I may request the basis for an action and use the applicable review or dispute process. A Training Center access decision does not itself revoke an AHA credential.

If I leave or my affiliation ends, I will stop representing an active affiliation, return or securely transfer required course and instructor records, and cooperate in resolving outstanding student documentation and card issues. Instructor transfers and inventory matters will follow applicable AHA procedures and any separate written terms. This acknowledgment does not establish employment, guarantee assignments or income, or replace a separate compensation or business agreement.

14 Instructor acknowledgment and signature

By signing below, I confirm that I have read and understand this agreement, have had an opportunity to ask questions, and agree to follow these responsibilities. I will review applicable policies and updates provided to me and seek clarification when needed. I understand that I remain responsible for accurate course delivery and documentation even when a Site administrator assists with scheduling, roster entry, or card processing.

Instructor full legal name: __________________________________________________
Business name, if applicable: ________________________________________________
Assigned Training Site: _____________________________________________________
AHA Instructor ID: _________________________________________________________
Authorized discipline or disciplines: __________________________________________
Email address: ____________________________________________________________
Phone number: ___________________________________________________________

Instructor signature: _______________________________________________________
Date: ___________________________________________________________________

For Training Center or Training Site administrative use
Received by: ________________________________ Date: ________________________
Policies provided and version or date: ________________________________________
________________________________________________________________________

Training Center preparation note: This reusable draft should be reviewed against the current AHA manual and your final written policies, and reviewed by legal counsel before adoption. Complete the policy delivery record for each instructor. AHA provides access to its Program Administration Manual through its instructor portal; resource page: https://cpr.heart.org/en/resources/aha-instructors (accessed September 28, 2026).