CCAR Class Registrion and Application

1
Who's Filling Out This Form* This field is required.
I am registering myself for the training.
I am registering someone else (e.g. staff member, client, participant)
2
Which Course Dates Are You Registration For?
Please Select
Please Select
Recovery Coach Academy: August 4th - 8th
3
Student Name* This field is required.(the person attending the training)
First Name
Last Name
4
Student Email* This field is required.(the person attending the training)
example@example.com
5
Student Phone Number* This field is required.(the person attending the training)
Area Code
Phone Number
6
Your Name* This field is required.(the person filling out this form, if different from student)
First Name
Last Name
7
Your Phone Number* This field is required.(the person filling out this form, if different from student)
Area Code
Phone Number
8
Your Email* This field is required.(the person filling out this form, if different from student)
example@example.com
9
Organization Name* This field is required.(if applicable)
10
I understand the required training manuals are purchased separately.* This field is required.Please email contact@safesiderecovery.com if you need assistance.
YESNO
11
I understand the student is required and responsible for attending all scheduled sessions.* This field is required.Please email contact@safesiderecovery.com if you need assistance.
YESNO
12
I understand student registration is not confirmed until payment is received.* This field is required.Please email contact@safesiderecovery.com if you questions regarding payment.
YESNO
13
Does the student have any accessibility needs, learning preferences, or notes we should know?
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Ok
Ok
14
CheckoutChoose your class or package.
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ORDER SUMMARY
Total costUSD
Recovery Coach Academy
$400.00Edit
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Ethical Considerations
$250.00Edit
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Professionalism
$150.00Edit
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Coaching in the Justice Setting
$150.00Edit
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Spirituality and Recovery Coaching
$150.00Edit
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Coachervision
$350.00Edit
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Full Certification Package Includes: Recovery Coach Academy, Ethical Considerations, Professionalism in Peer Support, and your choice of one elective — Recovery Coaching in the Justice System or Spirituality for Recovery Coaches.
$750.00Edit
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Total cost $0.00
First Name
Last Name
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