Registration

Course Registration Form

One Registration Form Per Student

Course Name:

Course Date:

Student Name(Last Name, First Name, Middle Initial):

Company Name:

Company Address:

Company Phone: Fax:

E-mail:

Home Address:

Home Phone: Cell:

E-mail:

Tuition is due seven (7) days prior to the first day of class. Checks are made payable to Design For Health Training Center. Please Note: Students will not be able to attend class and certificates will not be issued if payment has not been received or an arrangement has not been confirmed by our office. When Enrolling for a refresher course, you MUST submit a copy of your previous certificate with this registration form or bring the certificate with you to class.

Fee refunds are issued when one of the following occurs: 1.) If fewer than 3 people are registered 48 hours before the start date, the class is subject to cancellation. 2.) Design For Health Training Center shall refund the amount paid for a course if notice of cancellation is made prior to or on the first day of instruction. Requests for refunds are subject to a $25.00 processing free.

Start Time: All classes will begin at 8:30 AM unless otherwise specified.

Please print and fax a copy of this form

Fax To: 619 291-4318