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CNA Renewal Course Registration Form
Use this form to register for the Trinity Healthcare Services CNA Renewal Training Program.
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Today's Date
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STEP 1: STUDENT INFORMATION
First Name
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Your answer
Last Name
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Your answer
Phone Number
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Your answer
Email Address
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Your answer
Mailing Address
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Your answer
Unit or Apartment Number
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City
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Your answer
Zip Code
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Your answer
Emergency Contact Name
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Your answer
Relationship
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Your answer
Contact Number
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Your answer
STEP 2: COURSE AND COURSE COST
Select the program you would like to attend.
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CNA Renewal - $80
Required
Enter a preferred start date. (Visit our website for tentative session start dates.)
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STEP 3: METHOD OF PAYMENT
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Cash
Zelle (Send money to:
trinityhealthcareservicestx@gmail.com
)
PayPal (Use this link for pay:
https://PayPal.me/THSTX
)
Square (Please contact us for payment link.)
Required
How did you learn about our program?
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Our website
Facebook
Online Search
Referral (In the notes field below, please indicate who referred you to our program.)
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Notes:
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Your answer
STEP 4: PAYMENT
Submit this form then return to our website and complete Step 3 of the Registration Process by submitting your payment.
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