Trades Training Form
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Application Date  *
MM
/
DD
/
YYYY
Trade of Interest  *
Required
Name *
Over 18? *
Over 21 *
Address *
Mobile Phone Number  *
Do you agree to receiving text message reminders and invoices?
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Emergency Contact Name, Address, Cell, Work phone numbers *
Education
Diploma Received *
Highest Grade Level Completed  *
College? *
GED *
Required
GED Currently Enrolled *
Employment
Name of Employer *
Name of Supervisor
Address of Employer *
Phone Number of Employer
Permission to Contact Employer? *
Personal Issues/ Concerns
Do you have a valid Driver's License or State I.D?  *
Do you have a criminal record? *
Are you currently on probation? *
Are you on parole? *
Have you ever been arrested or have pending charges? *
Name of Probation officer and contact number
Name of parole officer and contact number
Work Info
What factors may prevent your daily attendance at work? *
Required
Please provide a brief description of why you would like to participate in your selected Trade of Interest.
 *

Please list 3 references we may contact, include a previous employer or teacher/ a friend you have known for more than a year/ a person that you go to for advice or counsel.

Please Provide their name and Phone numbers  *
PAYMENT
*TO RESERVE CLASS PLACEMENT, APPLICATION FEE MUST BE PROCESSED*


There is also a link to pay the application fee through our website under the Mary Kay Deen Education Center Tab. 

$50 Application Fee covers the cost of: 
-Application
-"Tools of The Trade" 2 week training

If you are submitting payment through pay pal you must include the following: 

Full Name 
Which Class you are registering for

Other payment options include payment with card in person using square Point of Sale or cash brought to the classes. 

All payments are final: There are no refunds if you decide to quit the class. 

The application fee is refundable. 



Please sign your name below to indicate you accept the terms of payment:
Would you require financial aid to attend this program?
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Please click how you will be paying for the application fee.
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Please click how you plan on paying for weekly classes.
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This serves as a digital signature. Please type your name and the date below to indicate you fully understand all of the form listed above. *
Personal Injury Waiver

This Personal Injury Waiver is made by the undersigned for the purpose of utilizing the facilities and premises managed by Pneuma Winds of Hope, Inc. with the location at 10408 MS-603, Bay St Louis, MS 39520, and in the acknowledgement that in the utilization of the premises and facilities of the Company, occupies risk of personal injury that may arise or happen at any time.

In consideration of Starfish Cafe & The Mary Kay Deen Education Center allowing the undersigned to make use of the venue and its facilities and equipment for the relevant purpose by which the Trades Training Program allows, the undersigned agrees to assume the foreseeable and unforeseeable risk of personal injuries related to the activity, and agrees to release, discharge, and hold harmless Pneuma Winds of Hope, its owner(s), employees, and volunteers free from any and all liabilities, claims, causes of action, damages, or losses, which may be incurred by the undersigned in using said premises and its equipment and/or facilities, and which may arise from any reason whatsoever, specifically including, but not limited to, any negligence on the part of the owners, its employees and volunteers, or losses arising from theft or for any other reason whatsoever. 

This waiver shall be binding upon the parties, their respective heirs, representatives, successors, and assigns. 

In case any part of this waiver be constructed as improper or invalid, such invalidity will affect only that part of this waiver and the rest shall remain valid and enforceable. 

Any alteration, modification, or amendment to this waver shall not be considered as valid unless otherwise written and signed by the undersigned herein.  

This serves as a digital signature. Please type your name and the date below to indicate you fully understand, acknowledge, and agree to what is listed above.

I hereby consent to be interviewed, recorded, photographed, videotaped or filmed by representatives of Pneuma Wind of Hope, Starfish Cafe, and MKD Education Center for purposes of publication, display or broadcast (print, web, digital display and all other forms of media).

 

I agree that such interviews, recordings, articles, quotes, photographs, films, audio or video and/or any reproductions of same in any form, are the property of the Pneuma Wind of Hope, Starfish Cafe, and MKD Education Center, and I relinquish any present or future claim for reimbursement for said photographic or film reproduction of my likeness or for said testimonials by me.

 

I hereby release the Pneuma Wind of Hope, Starfish Cafe, and MKD Education Center, its affiliates, employees, representatives and agents from any and all claims, demands, costs and liability that may arise from the use of these interviews, recordings, photographs, videotapes or films, and/or any reproductions of same in any form, as described above, arising out of being interviewed, recorded, photographed, videotaped or filmed.

 

I acknowledge that I have read this consent form in its entirety, or it has been read (or translated) to me, and I have had the opportunity to ask questions about it and understand it
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