Classic Home Care Training
Applicant Registration Form
Agency Name
Agency Owner (REQUIRED ATTENDANCE)
First Name
Last Name
Agency Director (Must Meet Minimum Qualifications)
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Desired Class Date
-
Month
-
Day
Year
Please see website for available class dates
Please choose at least one of the following selections:
Home Care Provider Training Course: $500 (**Special AUG and SEPT ONLY $395**)
HR & Client Forms ($1500)
Initial Licensure Policy & Procedure Pack ($2500) Aug and Sept only $900
Medicaid Training ($750)
Skilled Services Policy & Procedure Pack ($3200 each)
Consulting Services: $50/hr
Marketing (Website/Logo Design & Branding) Call for Quote
Bundle & Save (Licensure Class & In-Home Aide Procedures) $2250
Total Start Up Package (See Website for Details) $4500
CLIA Training Registration ($500)
CLIA Master Manual (Policies, Forms, Compliance etc ($300)
We require a deposit of 50% in order to secure your spot in class. Would you prefer to pay via:
Please Select
Zelle
Cashier/Certified Check
Please include phone number where you would like us to send your payment link:
I understand that this class is offered for educational purposes only and does not guarantee that the attendee will be granted a license by NC DHSR. Neither Classic Services, nor any of it's officers, directors, employees, or affiliates shall be liable for any direct, indirect, special, consequential, punitive, exemplary and/or incidental damages of any kind whatsoever (including but not limited to: loss of profits or attorney's fees) in any way due to, resulting from, or arising in connection with the Registrants acquisition or use of the Materials, or from the Registrants reliance on any information provided. This limitation applies to all causes of action in the aggregate including but not limited to: breach of contract, breach of warranty, negligence, strict liability, misrepresentation, and any other tort. Refunds are not offered; you may however reschedule to a different training date.
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