HHA104 Registration Form (in office)

Morning - 4 weeks

Monday, Wednesday, Friday | 9am-2pm

Evening - 6 weeks

Tuesday, Thursday | 5pm-9pm

Cost

Class Total: $550

$100 Deposit

Remaining balance of $450 due on first day of class

First Name*

As it appears on your government ID

Middle Name (optional)

Last Name*

As it appears on your government ID

Date of Birth*

Date

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Choose A Program Session*

Signature*

Payment Type*

CashCard

Registration Fee

Home Health Aide Registration FeeYou must pay the minimum registration fee of $100 (which will be deducted from your $550 tuition) to officially register for the course.

$100.00

Enter coupon

Total

$0.00

Payment Methods

Credit Card

Cash App Pay

I understand that a minimum payment of $200 is to be paid to K&K Healthcare Training Center 3 business days prior to the program start date.*

I understand

Would you like to be added to the waitlist for an earlier session?*

Which session would you like to be added to the waitlist for?