Student Information
Full Name
*
First Name
Last Name
E-mail
*
Phone Number
*
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Height
Eye Color
Date of Birth
*
-
Month
-
Day
Year
Gender
*
Male
Female
Upload ID Photo with white background
*
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Upload all Site Safety Certificates/OSHA
*
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Payments, Terms and Conditions:
For any credit card payments, a credit card authorization form is required if the payment is not made in person. Please contact the office for the form. A 50% deposit is required upon registration. 1A Accredited Bilingual Safety reserves the right to reschedule or cancel any course date(s) for any reason, including insufficient enrollment. In such instances, deposits will be returned or applied towards the next available training program. If you wish to cancel, reschedule, or change students, 5 days notice must be given. All DOB approved course completion certifications will be mailed to the individual that made the payment, unless other wise requested. No refunds or credits of any payment will be made for notification of withdrawal within 3 days of the start of the class, once the class has started or for missed classes. Only the student shall be entitled to access to his or her training records and/or related information. If a replacement certificate is needed, the student must pay the required fee, and show proof of identification before such replacement documentation is issued.
By my signature, I agree to the conditions of this agreement:
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