Compliance Training Agreement

Compliance Training Payment Form - Card

Growth Ability Services
Date Submitted

YearMonthDay
4 digit year, 2 digit month, 2 digit day
DSP Full Name
First and Last Name
Email
example@gmail.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Payment Method
GAS Rep Accepting Payment
GAS Rep Signature Date
In-House Trainings

Growth Ability Services provides CPR/First Aid, Article 9, and DCW trainings in-house. These trainings are offered to support DSPs in meeting state-mandated compliance requirements. The agency retains original certificates for all in-house trainings as part of the employee's record, and no cost is passed on to the DSP as long as certificates are retained by GAS. If a DSP requests that a certificate be released to them for personal use, the full cost of the training must be paid at that time before the certificate will be released.
Select In-House Trainings
CPR / First Aid Cost
Article 9 Cost
Internal DCW 1 Cost
Internal DCW 2 Cost
In-House Trainings Subtotal
External Trainings and Credentials

Growth Ability Services can assist DSPs with the registration process for external trainings. In these cases, DSPs must pay the full cost of the training up front. Upon payment, the agency will register the DSP for the selected class. It is the sole responsibility of the DSP to attend the training and pass all required components. If the DSP fails to complete or pass the training, they will be responsible for covering the full cost again should they choose to be re-registered through the agency.
Select External Trainings / Credentials
Fingerprints Cost
DCW 1 Training Cost
DCW 1 Test Cost
DCW 2 Training Cost
DCW 2 Test Cost
Prevention and Support Cost
HAH Training Cost
External Trainings Subtotal
TOTAL DUE FOR TRAININGS

TOTAL DUE FOR TRAININGS

USD

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

I acknowledge that payments are non-refundable and that it is my responsibility to attend, complete, and pass all trainings I register for.
DSP Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Should be Empty:

Compliance Training Payment Form - Card

TOTAL DUE FOR TRAININGS*

TOTAL DUE FOR TRAININGS