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Date of Birth
Date Format: MM slash DD slash YYYY
Have you earned a high-school diploma or GED?
Class(es) you wish to register for (Check all that Apply):
Certified Nursing Assistant (includes BLS, First Aid and HIV/AIDS) - $745
Home Care Aide (includes Orientation & Safety, Core Basic, Dementia, Mental Health, and skills) - $550
Dementia Level 1 - $80
Mental Health Level 1 - $80
Nurse Delegation Core - $50
Nurse Delegation Diabetes - $50
Continuing Education Units (12) - $80
Orientation & Safety Training - $50
HIV/AIDS Training - $80
BLS Healthcare Provider - $65
Heartsaver First Aid - $65
HCA Skills Refresher - $250
I agree to the following policies.
This agreement will be binding only when it has been fully completed, signed, and dated by the student and an authorized representative of the school prior to the time instruction begins.
CHANGES TO AGREEMENT NOTICE:
Any changes in the agreement will not be binding on either the student or the school unless such changes are acknowledged in writing by an authorized representative of the school and by the student, or student’s parent or guardian if he/she is a minor.
EFFECTIVE DATE OF ACCEPTANCE:
I certify that I have read and understand the cancellation policy and the complaint procedure; I have received a copy of the school catalog or brochure; and I am entitled to an exact copy of this Enrollment Agreement, school catalog, and any other pages I sign.
CANCELLATION OF CLASSES:
The school reserves the right to cancel a starting class if the number of students enrolling is insufficient. Such a cancellation will be considered a rejection by the school and will entitle the student to a full refund of all money paid.
CANCELLATION AND REFUND POLICY:
1. The school must refund all monies paid if the applicant is not accepted. This includes instances where a starting class is cancelled by the school.
2. The school must refund all monies paid if the applicant cancels within five business days (excluding Sundays and holidays) after the day the contract is signed or an initial payment is made, as long as the applicant has not begun training.
3. The school may retain an established registration fee equal to ten percent of the total tuition cost, or one hundred dollars, whichever is less, if the applicant cancels past the fifth business day after signing the contract or making an initial payment. A registration fee is any fee charged by a school to process student applications and establish a student record system.
4. If training is terminated after the student enters classes, the school may retain the registration fee established under (3) of this subsection, plus a percentage of the total tuition based on the percentage of training completed at the time of termination.
5. When calculating refunds, the official date of a student’s termination is the last day of recorded attendance:
a. When the school receives notice of the student’s intention to discontinue the training program; or,
b. When the student is terminated for a violation of a published school policy which provides for termination; or,
c. When a student, without notice, fails to attend classes for thirty calendar days.
6. All refunds must be paid within thirty calendar days of the student’s official termination date.
NOTICE TO BUYER:
Do not sign this agreement before you read it or if it contains any blank spaces. This is a legal instrument. All pages of this contract are binding. Read both sides of all pages before signing. You are entitled to an exact copy of the agreement, school catalog, and any other papers you may sign, and are required to sign a statement acknowledging receipt of those.
CANCELLATION OF CONTRACT:
If you have not started training, you may cancel this contract by submitting written notice of such cancellation to the school at its address shown on the contract. The notice must be postmarked no later than midnight of the fifth business day (excluding Sundays and holidays) following your signing this contract; the written notice may also be personally or otherwise delivered to the school within that time. In event of dispute over timely notice, the burden to prove service rests on the applicant.
UNFAIR BUSINESS PRACTICES:
It is an unfair business practice for the school to sell, discount, or otherwise transfer this contract or promissory note without the signed written consent of the student or his/her financial sponsors if he/she is a minor, and a written statement notifying all parties that the cancellation and refund policy continues to apply.
I certify that I read and understand the cancellation and refund policy and the complaint procedure; I received a copy of the school catalog and I am entitled to an exact copy of this enrollment agreement, school catalog, and any other papers I sign.
NOTICE OF FINANCIAL OBLIGATION
I agree to the financial obligations.
Washington law requires the following information to be supplied to each student enrolling in a private vocational school licensed under Chapter 28C.10 RCW. One copy of this notice bearing original signatures must be attached by the school as addenda to that individual’s enrollment agreement, as well as a copy provided to the enrollee by the school.
ACKNOWLEDGMENT BY ENROLLEE
1. I understand and accept that any contract for training I enter into with the above named school contains legally binding obligations and responsibilities.
2. I understand and accept that repayment obligations will be placed upon me by any loans or other financing arrangements I enter into as a means to pay for my training.
3. I understand that any enrollment contract I enter into will not be binding or take effect for at least five days, excluding Sundays and holidays, following the last date such a contract is signed by the school and me, provided that I have not entered classes.
ACKNOWLEDGMENT BY SCHOOL
Prior to being enrolled in this school, the applicant whose name and signature appears above has been made aware of the legal obligations he/she takes on by entering into a contract for training. Those discussions included cautions by the school about acquiring an excessive debt burden that might become difficult to repay given employment opportunities and average starting salaries in his/her chosen occupation.
STUDENT COMPLAINT NOTICE
I understand my rights and options for filing a complaint.
HOW TO FILE A COMPLAINT
Washington law requires private vocational schools to inform students how to file a complaint. By signing this form you acknowledge this process has been explained to you. Below are the next steps the school must take in discussing this policy with you, along with information about the complaint process.
DISCUSSION ABOUT COMPLAINT POLICY REQUIRED
First, a school representative must discuss the school’s complaint policy with you. Following this discussion, you will be provided with this attachment to sign. After you sign this form, the school will give you a copy for your personal records. The school will also keep a copy on file.
ACKNOWLEDGMENT OF COMPLAINT PROCESS BY STUDENT
- The school has described the grievance and/or complaint policy to me.
- I understand that the policy can also be found in the school catalog.
- I know I should first try to resolve a complaint or concern with my instructor or school administrator.
- I understand nothing prevents me from contacting the Workforce Board at 360‐709‐4600 at any time with a concern or complaint, and complaint forms are: http://wtb.wa.gov/PCS_Complaints.asp.
- I understand that I have one year to file a complaint from my last date of attendance.
- I further understand that in the event of a school closure, I have 60 days to file a complaint.
- I also understand that complaints are public records.
- Finally, I acknowledge that details about the complaint process, my rights, and any restrictions on the time I have to file a complaint can be found at http://wtb.wa.gov/PCS_Complaints.asp
Account Access Restrictions
I agree to the account access policy.
Site users must guarantee that they will not give username or password to any other individual, and will not log any other individual onto their account. Further, site users must certify that he/she shall be the only person who takes any course material under their username and password.
I understand the online training access term.
You will have access to the online training website for 60 days. If you need an extension, please contact the office, an additional fee may apply.
Limitation of Liability
I understand the liability limitation.
General Disclaimer and Limitation of Liability
You expressly agree that the use of this service is at your own risk. Neither S&H Training Center, Inc. nor any of its employees, agents, content providers or licensors makes any representations or warranties of any kind regarding the service, the content, any advertising material or the results that may be obtained from use of the service. This service is provided on an "as is" basis and S&H Training Center, Inc. specifically disclaims any express or implied warranties or guarantees of credit acceptance by state agencies. This includes without limitation, warranties of fitness for a particular purpose, warranties of merchantability or warranties against infringement. S&H Training Center, Inc., its affiliates, employees, agents, content providers and licensors shall in no event be liable for any damages or losses, including, without limitation, direct, indirect, consequential, special, incidental or punitive damages resulting from or caused by the service or its content, including, without limitation, losses related to your inability to use this service, any errors, omissions or defects in the content, or, any interruptions, delays in transmission or computer viruses. S&H Training Center, Inc. takes no responsibility for the timeliness of the information presented in the seminars, on the site or in our database. S&H Training Center, Inc. does not warrant that any material referenced or comments made within a course or included in our database is the only opinion or treatment available. As courses may be taken more than once, and in most states you may not take the same course within the same relicensure period for credit, the ultimate responsibility lies with the user if they take a course more than once.
STUDENT DATA COLLECTION FORM
The Workforce Board (the state agency that regulates this school) requires that we ask you for this information, by law (RCW 28C.10.050). Providing your social security number is voluntary. By law, the information you provide on this form cannot be given out by any state agency as public information. The Workforce Board will not disclose data to anyone except authorized Workforce Board employees or contractors working on specific research activities, who follow strict confidentiality procedures. This format follows the information required to be submitted by the school as part of the annual student data report.
Race (Check only one box)
American Indian or Alaska Native
Hawaiian Native or other Pacific Islander
Are you Hispanic in origin?
Are you disabled?
Are you a military veteran?
Highest grade completed
Less than high school graduation(less than 2 years)
High school graduate
Some post high school, no degree/certificate
Master’s degree or higher
Please check the box below
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