NURSE AIDE TRAINEE REGISTRATION FORM
Name: __________________________________ SS#:
____________________________
Address:
_________________________________________________
City: ____________________________ State:
__________ Zip: ___________________
Home Phone #:________________________
Work/Cell#:_________________________
Email Address:
________________________________________________________________
Start Date/Time: _________________________ Total _________
paid____________balance_______
Method of Payment: ____________________ Receipt #:
___________________________
Received by: __________________________
Date:_______________________________
REFUND PROCEDURE: If a student withdraws before
the first class a $10.00 cancellation fee will be assessed. A $25.00 withdrawal
fee will be assessed to students who withdraw the first day. NO REFUNDS WILL BE
GIVEN AFTER THE SECOND SCHEDULED CLASS. Each student must register two weeks
prior to the start date to avoid late charges.
Please Initial
__________ I am aware, that if I have a criminal background (felony,
misdemeanor, etc.), it may hinder employment.
TRUTH IN LENDING
Cost of credit is not included in the cash price of this program. NOTICE:
Any holder of this consumer credit contract is subject to all claims and
defenses which the debtor could assert against the seller of goods and services
obtained pursuant hereto with the proceeds hereof. Recovery hereunder by the
debtor shall not exceed amounts paid by debtor. If a student is granted extended
payments, said payments shall not be more that (3) three installments. All
student balances must be paid within 30 days of the last date of attendance as
determined by the college. There will be no carrying charges or service charges
connected with these payments other than the cancellation and withdrawal fees
referenced above. Upon the end of the contract, we reserve the right to employ
all legal remedies to obtain outstanding balances, including the use of a
collection agent.
PLEASE READ THE BACK OF THIS FORM BEFORE SIGNING.
By signing my name below, I state that I have read
both sides of this form and I understand that I am liable for amounts set
herein.
Signature: _____________________________ Date:
______________________