Course Registration Form

Student Registration Form
Student Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Student E-mail
Mobile Number

Area CodePhone Number
Georgia CNA Number- Medication Aide Class Only
Certified Medication Only Class Schedule
Additional Comments
My Products
prevnext( X )
Registration Fee for Both Medication Aide or CNA.$25.00
Certified Medication Aide and CNA NON- REFUNDABLE

Quantity
Item subtotal:$0.00

Medication Aide Deposit $150.00
Deposit is NON-REFUNDABLE this is require to secure your seat for class.

Quantity
Item subtotal:$0.00

Georgia Medication Aide $300.00
You MUST be a CNA in the state of Georgia and in good standing with an active certification to take this 2 day class.

CNA Training Deposit $450.00
Deposit is require to secure your seating for class. NON_REFUNDABLE

Georgia CNA Training Program $1,250.00
This class will training you to become a state Certified Nursing Assistant in little as 6 weeks.

Proxy Caregiver Training $200.00
To administer medications in group homes, assisted living and personal care homes.

BLS for Healthcare $75.00
This class is primarily for that work in the healthcare field.

Heart Saver CPR AED and 1st Aid $65.00
This class is primarily for non-healthcare workers for those that need to be certified in CPR training.

BLS CPR Instructor $325.00

Heart Saver First Aid Only $40.00

FAMILY AND FRIENDS CPR $25.00

BABYSITTING TRAINING $100.00

Total $0.00
Signature

Clear
Scrub Size (CNA TRAINING ONLY)
T-Shirt Size (CNA TRAINING ONLY)
Please upload documents 2 forms of ID, TB Results

Browse Files

Cancelof

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Student Registration Form