Pediatric Advanced Life Support (PALS) Instructors’ Course

October 3, 2012

A PALS Instructor is someone who has a solid understanding of pediatric advanced life support and knowledge of adult learning principles. The PALS Instructor course consists of completing the Core Instructor Module prior to the in-class course, participating ina whole day of course instruction, and, within six months of course date,being monitored while teaching in other PALS courses. Interested applicants should complete the attached registration form, and attach the following:

  1. A written statement which includes the following:
  2. A brief description of current or previous employment relevant to teaching PALS:
  3. A brief description of relevant teaching experience:
  4. Discussion of your strengths (personal & professional) relevant to teaching PALS:
  5. The name and contact information of your manager or supervisor. This individual will be contacted for a reference and to determine program support.
  6. A copy of your current PALS Provider card

Instructor Candidate Commitment:

If accepted to this Instructor Course, I acknowledge and agree to the following

  • Audited teaching will be required as a component of this instructor course
  • Audited teaching will consist of a minimum of one half day teaching skill stations and one-half day teachingcore case discussions and simulations. Additional hours may be required at the discretion of the course director
  • Audited teaching hours will not be reimbursed as they are a required component of the instructor course
  • Audited teaching should occur as soon as possible, and no longer than 6 months after, completion of the classroom day on October 3, 2012.
  • Documents to support registration with the Heart & Stroke Foundation of Ontario (HSFO) will be submitted when all components of the PALS Instructor Course (Core Instructor Module, October 3 in-class day, and audited teaching) are complete
  • Courses taught during audited teaching are not included in the three (3) courses that an instructor must teach every three (3) years to remain current according to HSFO standards.

Signature of Instructor Candidate: ______Date: ______

Successful candidates will be notified by the Course Director, Dr. Andrew Latchman.

Registration Form ATTACHED. For further information contact

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**FOR OFFICE USE ONLY:

Date Received: ______

Registration Form / Registration Fee
Name: / Course* / $300
Address: / * Course fee does not include PALS Instructor
Manual and registration with Heart & Stroke
Foundation of Ontario
Cancellation Policy
  • If, after being notified of your acceptance to the course and confirming your attendance, you subsequently request a cancellation of your registration, a $100 administrative fee will be deducted from your registration fee
  • Substitutions are not possible as instructor candidates must be pre-selected for the course
  • No refunds are given after the start of the course
  • No refunds will be given for “no shows”

# Street / City
Province / Postal Code
Phone:
Email:
Affiliated Institution:
AEMCA
MD
RN / RRT
Other, please specify:
Payment Method
Cheque
If paying by cheque, please make cheque payable to
“Hamilton Health Sciences, Outreach Program”
Credit Card – If paying by credit card, please provide the following information:
The Critical Care Outreach Education program at McMaster Children’s Hospital endeavors to provide an exemplary course experience, however, in rare situations courses may be cancelled due to unforeseen circumstances. If it becomes necessary to cancel a course, registrants will be given the option of enrolling in a future course or receiving a refund.
Card Type:
VISA
MasterCard
American Express
Name of Cardholder: / Return Registration to:
Card No: / Simulation & Outreach Program
Attention: Diane Brophy
McMaster Children’s Hospital
1200 Main Street West, Room 1C23B
Hamilton, ON
L8N 3Z5
Expiry Date:
Registration Fee:
Signature:

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**FOR OFFICE USE ONLY:

Date Received: ______