Facility Registration

Facility Invoice for Registration

Fill out the following form if you would like to be invoiced for any student(s) you are registering. You are also given the option to pay by credit card if you wish.
*Important note: If you are registering students for a CMA or CNA class in Kansas, you will need the course information. (i.e., Course Approval Number and/or Clinical Site Location) There is a link below the course dates with that information and a link to the clinical hours and dates.
For registration questions please call or email:

Danielle Gray 888-932-2501 ext 116

Dgray@wecareonlineclasses.com
Facility Information
Your Name*

First NameLast Name
Duplicate Name
Facility Name*
Your Email Address*
example@example.com
Your Phone Number*
Please enter a valid phone number.
Do you want to pay today? (Note: accounts 90 days past due will be placed on an accounting hold and assess a 5% late fee)*

Yes, I'll pay today with a credit cardNo, please send me an invoice
Has your facility received an invoice from We Care Online in the past?*

YesNo
Accounts Payable Contact Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
Tax ID Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Information

You will need the student's name, email and phone number. Depending on the course, you may be required to submit the student's Social Security Number, license or certification number, and address. Important: The name you type in MUST be student's LEGAL NAME. It must match the name on the Kansas Driver's License or State ID to meet KDADS requirements!
Student Name (Student name can not be the same as the Facility Contact Name)*

First NameLast Name
Duplicate Student Name
Student and Facility name cannot be the same!!
Email for Student*
example@example.com
Phone Number*
Please enter a valid phone number.
Course Student 1*
Please be sure to choose a state or all states
Which CMA Course Date?*

Which CNA Course Date?*
If your course is not listed, please add it here
Restorative Aide Course Date for Student 1
Restorative Aide Course Date for Student 2
Restorative Aide Course Date for Student 3
Restorative Aide Course Date for Student 4
Restorative Aide Course Date for Student 5
Restorative Aide Course Date for Student 6
Home Health Aide Course Date for Student 1
Home Health Aide Course Date for Student 2
Home Health Aide Course Date for Student 3
Home Health Aide Course Date for Student 4
Home Health Aide Course Date for Student 5
Home Health Aide Course Date for Student 6
CMA Update Course Date for Student 1
CMA Update Course Date for Student 2
CMA Update Course Date for Student 3
CMA Update Course Date for Student 4
CMA Update Course Date for Student 5
CMA Update Course Date for Student 6
Clinical Location Site*
Which class date?*
Course Approval Number*
Location of state exam*
Location of CMA state exam*
Date of Birth*

MonthDayYear
Date
Please enter the student Social Security Number. This number will be used for certification and testing purposes and MUST BE CORRECT. If the Social Security Number is incorrect, the student WILL NOT BE REGISTERED.
Social Security Number*
Confirm Social Security Number*
**ERROR: The numbers do not match, please check your entries.
Certification or License Number*
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Would you like to add a second student?*

YesNo
Student 2 Name *

First NameLast Name
Email for Student 2*
example@example.com
Course Student 2*
Please be sure to choose a state or all states
Which CMA Course Date?*
Which CNA Course Date?*
Course Approval Number
Clinical Location Site
Which class date?*
Where would the student take the state exam?*
Where would the student take the CMA state exam?*
Phone Number*
Please enter a valid phone number.
Student 2 Social Security Number*
Confirm Student 2 Social Security Number*
**ERROR: The numbers do not match, please check your entries.
Date of Birth*

MonthDayYear
Date
Certification or License Number*
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Would you like to add a third student?*

YesNo
Student Name 3*

First NameLast Name
Email for Student 3*
example@example.com
Course Student 3 *
Please be sure to choose a state or all states
Which CMA Course Date?*
Which CNA Course Date?*
Course Approval Number
Clinical Location Site
Which class date?*
Where would the student take the state exam?*
Where would the student take the CMA state exam?*
Phone Number*
Please enter a valid phone number.
Student 3 Social Security Number*
Confirm Student 3 Social Security Number*
**ERROR: The numbers do not match, please check your entries.
Date of Birth*

MonthDayYear
Date
Certification or License Number*
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Would you like to add a fourth student?*

YesNo
Student Name 4*

First NameLast Name
Email for Student 4*
example@example.com
Course Student 4*
Please be sure to choose a state or all states
Which CMA Course Date?*
Which CNA Course Date?*
Course Approval Number
Clinical Location Site
Which class date?*
Where would the student take the state exam?*
Where would the student take the CMA state exam?*
Phone Number*
Please enter a valid phone number.
Student 4 Social Security Number*
Confirm Student 4 Social Security Number*
**ERROR: The numbers do not match, please check your entries.
Certification or License Number*
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Would you like to add a fifth student?*

YesNo
Student Name 5*

First NameLast Name
Email for Student 5*
example@example.com
Course Student 5*
Please be sure to choose a state or all states
Which CMA Course Date?*
Which CNA Course Date?*
Course Approval Number
Clinical Location Site
Which class date?*
Where would the student take the state exam?*
Where would the student take the CMA state exam?*
Phone Number*
Please enter a valid phone number.
Student 5 Social Security Number*
Confirm Student 5 Social Security Number*
**ERROR: The numbers do not match, please check your entries.
Date of Birth*

MonthDayYear
Date
Certification or License Number*
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Would you like to add a sixth student?*

YesNo
Student Name 6*

First NameLast Name
Email for Student 6*
example@example.com
Course Student 6*
Please be sure to choose a state or all states
Which CNA Course Date?*
Which CMA Course Date?*
Course Approval Number
Clinical Location Site
Which class date?*
Where would the student take the state exam?*
Where would the student take the CMA state exam?*
Phone Number*
Please enter a valid phone number.
Student 6 Social Security Number*
Confirm Student 6 Social Security Number*
**ERROR: The numbers do not match, please check your entries.
Date of Birth*

MonthDayYear
Date
Certification or License Number*
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Facility for Clinical Portion
RN Clinical Instructor Name and License Number
Clinical Instructor Phone and Email
Subtotal
Your total is ${subtotal}. Our Accounting department will email an invoice soon!
The course(s) you have chosen requires either a college transcript or a reading test to be submitted before the registration is complete.

Up to 2 hours
Prerequisite: None
Price: $40

Schedule the reading test here: Click Here

Email dgray@wecareonlineclasses.com or call 888-932-2501 ext 116 for more information
Your total is ${subtotal}. Click submit to review your order and pay.
By enrolling a staff member in a course with We Care Online, the facility acknowledges and agrees to the following terms and conditions.
- The facility understands that upon enrolling a student, they are fully responsible for the payment of the course fees, regardless of whether the student begins the course, engages in the course, or successfully completes it. This payment obligation is binding even if the student fails to complete or pass the course.
- The facility accepts financial responsibility for the course fee regardless of the student’s employment status. This means that if the student quits, is terminated, or is otherwise no longer employed by the facility after enrollment, the facility remains obligated to pay the full course fee.
- The We Care Online refund policy will apply; however, once the refund period has passed, no refunds or fee reductions will be provided under any circumstances.
- Payment is due upon receipt of the invoice and must be made within the time specified on the invoice.
- Accounts 90 days past due will be placed on an accounting hold and assess a 5% late fee.
Course Prerequisites
Some courses may require proof of licenses, identity, or textbooks. Failure to provide required items may result in a non-passing grade. Please check your email for instructor instructions.

Marketing Emails and Texts
By signing this agreement, you agree to receive course-related emails and texts. To opt out, click “unsubscribe” in emails or reply “STOP” to texts.

For Scheduled Courses
Balances must be paid in full before the course start date. If not, you will be removed from the course and the Registration Fee is forfeited.

For Open Enrollment Courses
Full payment is required to enter the classroom. If payment is not made within 30 days of enrollment, you will be removed and the Registration Fee is forfeited.

We Care Online’s Right to Cancel
We Care Online may refuse service or cancel enrollment at any time for academic, attendance, financial, or conduct reasons. No refund will be given in these cases.
If a course is canceled due to system downtime or unforeseen issues, refunds will follow the policy below, minus the non-refundable Registration Fee:
- 0–25% or 3 days complete (whichever comes first): 100% refund of tuition
- 26–100% complete: No refund
Refund Policy – Buyer’s Right to Cancel
- Students may cancel enrollment and obtain a refund prior to the course start date.
- Refunds are granted according to the following schedule (except CNA, CNA Refresher, Paid Nutrition Assistant, and CMA courses — see note below):
- 0–25% of course or 3 days complete (whichever comes first): 100% tuition refund.
- 26–100% complete: No tuition refund.
- Important: For CNA, CNA Refresher, Paid Nutrition Assistant, and CMA courses, refunds are only available if the request is made before the course start date. Once the course begins, no refunds or transfers are allowed for these courses.
- Course completion is determined by the number of days since the official start date, not by the student’s progress.
- Refunds will be processed within 60 days of the last day of attendance or from the receipt of payment (whichever is later).
- The Registration Fee is non-refundable. Course transfers may be requested one time without paying the fee again; a second transfer will require repayment of the fee.
Dispute Resolution
Students (or paying facilities) agree to contact We Care Online directly with billing concerns before filing a chargeback. Chargebacks filed outside this policy will be disputed with enrollment and service records, and may result in denial of future enrollment.

Facility Paying for Student
If a facility pays for a student by invoice, payment is required regardless of course completion or grade. Refund policy above applies.

Placement Disclaimer
We Care Online does not guarantee employment after course completion.

Right to Reschedule
We Care Online may reschedule or extend a course in the event of technical issues, low enrollment, or emergencies. Backup instructors may be assigned if needed.

Other Acknowledgments
- I affirm the accuracy of the information I provided.
- I have basic computer skills or assistance. Technical support is available in Canvas; instructors are available by email/phone as listed in the syllabus.
- I am responsible for my own work and agree to treat this course as a professional learning experience.
- I give permission for We Care Online, LLC to run a background check if required by the clinical facility.
- I give permission for my photographic likeness to be used lawfully for educational or promotional purposes.
- I understand that private patient information may be shared during lab/clinical sessions. I agree to protect confidentiality and follow HIPAA requirements. I understand violations may result in fines and/or imprisonment.
Check this box to agree*

I agree to these terms and conditions.
Should be Empty:

Facility Invoice for Registration

Facility Information

Student Information