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Indianapolis CNA Training Program
Classes every month!
Register today
Limited seats available
First Name
Last Name
Email
Phone
Which class dates are you registering to attend?
Choose an option
The Criminal History and CNA Registry Check for all potential states were verbally explained to student
Address
Are you at least 16 years old?
*
Yes
No
Date of Birth
I understand that I am ultimately responsible for the timely payment of all course costs and fees.
*
Yes
No, I do not wish to continue registration at this time
How do you intend to pay for the class? ($2,500 total)
Choose an option
Emergency Contact Name
Emergency Contact Phone #
What size scrubs do you wear?
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Are you fluent in reading and writing English?
*
Yes
No
Do you have reliable transportation to class and the clinical site as assigned?
*
Yes
No
Do you understand that the CNA program is accelerated and will require your presence Monday--Friday for three weeks, as well as independent studying outside of class times?
*
Yes
No
Attendance for CNA students is critical. Absences or tardiness of any kind may be cause for student removal from the program. Do you understand and agree to comply with the attendance requirement?
*
Yes
No
Do you have any prior experience in healthcare? If yes, please describe.
The CNA program grading scale requires students to maintain an average grade of 80% or higher in order to be eligible for clinical placement and continued clinical rotations. Do you understand the grading scale as described above?
*
Yes
No
CNA Students are prohibited from wearing long or artificial nails. Fingernails must be short and clean. It is at the instructor's discretion as to whether nails meet the school guidelines. Do you understand and agree to follow this fingernail requirement?
*
Yes
No
Release of Liability and Assumption of Risk I am enrolling as a student in a course offered by Indiana School of Certified Nursing Assistants, LLC. I understand that my training involves physical activities which have a risk of physical harm to me. I hereby release and forever discharge Indiana School of Certified Nursing Assistants, LLC, their employees, officers, directors, agents, and assigns, from any and all claims, demands, actions, causes of action, injuries or suits of any kind or nature whatsoever resulting from my participation in the course of study provided by IS-CNA. I assume all risk of injury to myself while participating in this course of study. I declare that I am aware of the physical demand of the course of study. I represent that I have no physical limitations that would render me unable to perform the physical activities of the course of study. I declare that the terms of this instrument have been completely read, fully understood, and voluntarily accepted.
Your Signature
Clear
Today's Date
I cosent to being contacted by call, text, or email. I understand that this consent may be revoked upon request.
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