Classic Home Care Licensure Training Course
Applicant Registration Form (Please DO NOT submit Multiple Applications )
Applicant Name
****ONE CERTIFICATE PER AGENCY.IF A SEPERATE CERTIFICATE IS REQUESTED STUDENT WILL HAVE TO SUBMIT ANOTHER PAYMENT OF $400.THANK YOU****
Agency or School Owner (REQUIRED ATTENDANCE)
First Name
Last Name
Agency or School Director (Must Meet Minimum Qualifications) *If you do not know whom that will be. Leave blank or put your name.
First Name
Last Name
Please add the First and Last names of anyone else besides yourself who will be attending this course. Add N/A if you will be the only one. (Be advised this person MUST also be on CAMERA and a Partnership under Secretary of State if they are being added to your Certificate)
*
Franchise Company
*
Yes
No
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Desired Class Date
*
-
Month
-
Day
Year
****Please see website for available class dates ****(FRIDAYS ONLY)*NO CLASS LAST FRIDAY EVERY MONTH*
We require a deposit of 50% in order to secure your spot in class. Would you prefer to pay via: OTHER payment options are listed at the bottom of this Application
Please Select
Cashier's Check (we must have check before class spot is secure)
OTHER payment options are listed at the bottom of this Application
Please include phone number where you would like us to send your payment link:
Please select a service or product. Policies, Forms and Manuals are NONREFUNDABLE. No EXCEPTIONS
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Home Care Provider Training Course: $400
**Course Price Covers up to 2 People.3 or More costs $100 Per Person**
$
400.00
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HR & Client Forms $400
$
400.00
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Initial Licensure Policies
$
898.00
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Medicaid Training Manual $300
$
300.00
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Nursing Skilled Services Policies
$
1,448.00
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Consulting Services: $200/hr
$
200.00
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Marketing (Website/Logo Design & Branding) Call for Quote
$
Free
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Bundle & Save (Licensure Class & In-Home Aide Procedures)
$
1,150.00
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Total Start Up Package (See Website for Details) $2800
$
2,800.00
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Employee Handbook
$
250.00
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Family Home Polices
$
898.00
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Consulting opening your own CNA School
$
3,000.00
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Consulting opening your own Proprietary School
$
5,000.00
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Franchise Companies Prices for Polices start at $2000-$3500 call for special bundles policy prices.
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Free
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Respiratory Therapy
$
898.00
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Physical Therapy
$
898.00
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Occupational Therapy
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898.00
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Speech Therapy
$
898.00
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Medical Social Work
$
898.00
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Durable Medical Equipment
$
898.00
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Nursing Pool
$
1,448.00
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Nursing Services
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1,448.00
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Infusion Nursing
$
1,448.00
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Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
Print Name
Title
I understand that this class is offered for educational purposes only and does not guarantee that the attendee will be granted a license by NC DHSR. Neither Classic Services, nor any of it's officers, directors, employees, or affiliates shall be liable for any direct, indirect, special, consequential, punitive, exemplary and/or incidental damages of any kind whatsoever (including but not limited to: loss of profits or attorney's fees) in any way due to, resulting from, or arising in connection with the Registrants acquisition or use of the Materials, or from the Registrants reliance on any information provided. This limitation applies to all causes of action in the aggregate including but not limited to: breach of contract, breach of warranty, negligence, strict liability, misrepresentation, and any other tort. Refunds are not offered; you may however reschedule to a different training date.
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