Utopian Healthcare Caregiver Training Registration

UHC Caregiver Training - Registration Form

Registration form
Program Type*
2025 Training Schedule
Batch A - Jan 13th to 31st 2025Batch B - Feb 10th to 28th 2025Batch C - Mar 10th to 28th 2025Batch D - Apr 7th to 25th 2025Batch E - May 5th to May 23rd 2025Batch F - Jun 2nd to Jun 20th 2025Batch G - Jun 30th to Jul 18th 2025Batch H - Jul 28th to Aug 15th 2025Batch I - Aug 25th to Sep 12th 2025Batch J - Sep 22nd to Oct 10th 2025Batch K - Oct 20th to Nov 7th 2025Batch L - Nov 17th to Dec 5th 2025
AbujaEnuguLagos
Name (Please provide your name exactly as you would like it to appear on your certificates).

Surname/Last NameFirst NameMiddle Name
Phone Number*
Please enter a valid phone number.
Date of Birth

DayMonthYear
Date
Date of Birth

DayMonthYear
Email Address*

Confirmation Emailexample@example.com
Qualification
Your Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Batch A - Sep 7th to Nov 10th 2024
NOTE: Weekend Programs are only available in our Enugu and Lagos locations
Instagram (Meta)FacebookLinkedInTwitterTikTokWebsiteGoogleAproko doctorRadio advertCommunity outreachWord of MouthUtopian InternsReferral from others (not including prior students)Referral from a prior student (Please provide student's name)
Surname ( Please provide your name exactly as you would like it to appear on your certificates).*
Surname
Name ( Please provide your name exactly as you would like it to appear on your certificates).

Middle NameFirst Name
Name of Next of Kin / Emergency Contact

First NameMiddle NameSurname/Last Name
Address of Next of Kin

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number of Next of Kin
Please enter a valid phone number.
I have SSCE CertificateI do NOT have SSCE Certificate
Please upload your SSCE Certificate (You may be required to submit a copy at the training center)

Cancelof
Please upload your recent Identification document (example - International Passport or Driver License)*

Cancelof
Reason(s) for attending this training:
YesNo
YesNo
Enter Your Promo: ID
Date of Signature *

MonthDayYear
Date
Hour MinutesAM/PM Option
American Heart Association BLS Certification

Application
YesNo
Consent for Use of Images

I. Introduction

This consent form is presented by Utopian Healthcare. By signing this document, you agree to allow Utopian Healthcare to use your photographs or images in their advertising and social media postings.

II. Description of Use

1. Purpose: The images may be used for promotional, educational, or informational purposes related to the services and programs of Utopian Healthcare.

2. Platforms: This includes, but is not limited to, print media, online advertisements, social media platforms, and the Utopian Healthcare website.

III. Voluntary Participation

1. Participation is completely voluntary. You have the right to refuse or withdraw your consent at any time without any negative consequences.

2. If you decide to withdraw your consent, it is your responsibility to inform Utopian Healthcare in writing. Upon receipt, Utopian Healthcare will cease the use of your images in future materials but cannot retract materials already published or distributed.

IV. Rights and Permissions

1. By signing this form, you grant Utopian Healthcare the right to use and publish the images provided.

2. Utopian Healthcare will not use the images for purposes other than those stated without obtaining further written consent.

3. There is no time limit on the validity of this consent nor is there any geographic limitation on where these materials may be distributed.

4. This consent is not exclusive to Utopian Healthcare, meaning you may grant similar rights to other organizations.
Use ImageDon't Use

UHC Caregiver Training - Registration Form

2025 Training Schedule

NOTE: Weekend Programs are only available in our Enugu and Lagos locations

American Heart Association BLS Certification