Personal Caregiver Aide (PCA) Form

Course Details

Course Title: Personal Caregiver Course

Duration: 8 Hours

Fee: $349.95 (To be paid upon registration)

It is an 8-hour class with lunch included.

Upon completion, all participants will receive a certificate of completion.

Please submit preferred 2 dates and we will contact you to confirm

Currently offered on Sundays only.

Time:

8:30 am-4:30 pm with hands-on skills session

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Full Name

Date of Birth

Email Address

Phone

Disclaimer: Completing this enrollment does not guarantee employment or certification.

Preferred Course Date(s):

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Training Date 1:

Training Date 2:

Training Date

Flexible / To be Decided

*Please expect a call from Level Up to confirm your class date and time.

Special Requirements or Comments:

AGREEMENT

By submitting this form, you agree to pay the course fee of $349.95 upon registration and acknowledge that payment is required to secure your spot in the course.

I further acknowledge this fee is non-refundable. You may reschedule to the next available date at the directors discretion. While we refer participants to employers, completing this class does not guarantee employment.

Do you understand and agree to the terms above?

Yes, I understand and agree to the terms and the privacy policy of the organization.

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Student's Signature

Date

Note: You will be redirected to the Payment Page after submitting

Price: $349.95