Dear Applicant:

Thank you for your interest in 4YourCNA’s CNA Test Prep Course. This course is designed to review all you will need to know to pass the certification exam to become a Certified Nursing Assistant and will assist you in developing the skills you need to become a respected member of the healthcare team.

Registration fees are due with the registration application and a seat will not be reserved for you if payment does not accompany the application, or if the application is incomplete. The cost of the class includes all instruction, workbook, skills book, handouts and use of textbook. It does NOT cover the cost of the test or background screening fees of $80 (if applicable). Testing fees are $155 (payable to Prometric, the testing agency) and registration assistance will be offered during the class. Additional supplies may be necessary. See Terms and Conditions for more information. There are no refunds after registration is complete.

Please fill out the following application entirely. Class size is limited to the first fourteen registrants that have submitted a completed application and remitted all fees.

We hope to see you in class!

Best Wishes,

Patricia Laramee, RN
Instructor

Home of the #1 CNA Test Prep Video Series on YouTube!

Additional Information can be found at www.4YourCNA.com

Fees for the class include textbook, CNA Skills Study Guide and many supplies. CNA class also includes classroom livestream, test registration instructions and online course. Fees for classes are: CNA Test Prep $350 (payment plan is available). Some additional supplies are required: blood pressure cuff (manual kind, not automatic), stethoscope (not attached to blood pressure cuff) and 1 set of solid scrubs in Royal Blue, Red or Black. You will receive all your books at the beginning of class. They are not available before class starts. The textbook is the property of 4YourCNA and will be available for use during the course of the class but must be returned on the last day of class. If you would like to purchase a textbook to keep, the CNA Handbook is $42.00, (plus tax). Each textbook will be assigned to a student. The textbook must be returned in the same condition it was assigned. Do not highlight information or make notes in the textbook. For the CNA class, you will also receive a skills book that is yours to keep and write in. In the event that a textbook is lost, stolen or damaged, the student will be responsible for the replacement cost of that book. Fees for State or National examinations are not included in the cost of the class.

You are entering into an agreement with 4YourCNA of your own free will. These courses are designed to review the basic skills you will need to pass the state examination. This is done strictly in a classroom clinical lab setting. There is no provision for practicing your skills on “live patients”. You will be practicing these skills on other currently enrolled students and you attest that you are granting permission for students to practice skills on yourself. 4YourCNA does not assume any liability for any harm done, inadvertently or intentionally, to yourself or others for any portion of any class. No assumption of liability may be made for any injury you may incur before, during or after class. If you feel you are unable to safely perform a skill, it is your responsibility to notify an instructor PRIOR to attempting the skill to reduce the risk of injury to yourself or others. If, during practice, you feel that another student is performing a skill that may put you in danger, it is your responsibility to stop the skill and notify the instructor so that additional training may be offered. By submitting this application, you absolve 4YourCNA from any and all liability from any injury to yourself or any other person you are practicing your skills on, that may occur on or off property, as a result of practicing any skills you have learned from 4YourCNA staff, and any injury that may occur while you are in class or on premises. 4YourCNA also assumes no liability for any practice you choose to do outside of the classroom setting.

4YourCNA does not require proof of a recent physical exam or “Freedom from communicable disease” affidavit prior to enrolling in a class. However, it is the student’s responsibility to assess their overall level of health and determine if this career is within their range of abilities. If you feel you are unable to perform any of the tasks listed below, we urge you to discuss this career choice with your physician PRIOR to enrolling in one of our classes. If you are enrolling in ANY health care class, you should be able to perform a wide variety of physical tasks including, but not limited to: bending (from the waist and side to side); Kneeling; Twisting; Reaching (to the side, above your head, and in front of your body); standing and walking for 8 hours. Additionally, CNA students should be able to lift 50 pounds. To perform adequately as a health care worker, you should be able to perform these motions with reasonable accommodations and be in reasonably good health. By submitting this application, you are acknowledging receipt of this notification of physical requirements, waiving any liability on the part of 4YourCNA if you should not be able to complete the class or pass the state exam due to physical limitations that you presently have or may develop, and releasing 4YourCNA from any liability should you become injured while performing or practicing any skills that require these basic minimum physical requirements. While 4YourCNA does not require a physical, most health care establishments do require a physical exam prior to hiring a health care worker. You are encouraged to obtain a physical exam during the course of this class to prepare for employment.

4YourCNA classes are adult education offerings designed to give the information and/or clinical skills necessary for an enrolled student to successfully pass a state exam. There are no attendance requirements for the test prep classes. There are NO MAKEUP classes. Students are responsible for all material they may have missed while absent; If you are unable to attend or tardy, it is your responsibility to contact another class member to cover missed material. The instructor WILL NOT demonstrate skills or review theory to students that do not attend classes.

4YourCNA strives to teach you the skills you need not only to pass the state exam, but also to perform competently in your new career. To do this in such a short period of time, we must rely on both our students and our faculty to maintain an environment conducive to learning. This is to inform you clearly of our expectations and outline some of the behaviors that will not be tolerated within the classroom setting or on campus. This is NOT a comprehensive list and issues will be addressed on an individual basis. You are expected to: arrive to class on time and demonstrate a willingness to learn; give the speaker your attention; treat your classmates with respect; be courteous and polite at all times; not use profanity; follow the safety rules at all times; notify the instructor if you do not understand a subject or skill; treat the equipment with respect; immediately notify the instructor of any equipment malfunctions; you will keep all cell phones turned to the “vibrate” or “off” position during class; you will smoke ONLY in the designated smoking areas; and clean up after yourself, leaving the classroom and clinical room neat and orderly. IF A STUDENT KNOWINGLY OR WILLINGLY VIOLATES ANY OF THE SAFETY RULES TO INTENTIONALLY INFLICT HARM ON ANOTHER, HE OR SHE WILL BE IMMEDIATELY EXPELLED FROM THE CLASS. By submitting this application, you certify that you agree to abide by the code of conduct rules and you understand that disciplinary action, up to and including expulsion, may result from any infraction of these rules at the sole discretion of the instructor. You agree to contribute to a safe, cooperative learning environment and will treat all students and instructors with respect.

The clinical skills lab is available for practice during the time you are scheduled to be in class and for the 30 minutes after class ends. Additional unsupervised lab time is offered on Mondays and Wednesdays from 1:30pm until 4pm. Students must be in uniform, with their ID badge on during practice times. Unsupervised practice time means that an instructor is not available to correct or observe students performing skills and any injury that may occur is the sole responsibility of the practicing student. All supplies are expected to be stored neatly, all linens refolded and stored in their proper position, all beds should be neatly made and the skills manikin should be dressed appropriately prior to the student leaving the skills lab.

4YourCNA offers all enrolling students a payment plan for class. Students may pay in full at the time of registration ($350) or opt for a payment plan which requires a deposit of $175 during registration. The balance of $175 will become due the first day of class. There are no refunds for class registration. Any student that does not complete payment prior to the end of the first class will not be eligible to continue in the class and will forfeit their deposit. Any student that does not attend the first class without notifying the instructor at least 24 hours prior to the start of class will forfeit their deposit, unless the balance is paid in full prior to the start of the second class session. Any student that notifies 4YourCNA at least 24 hours prior to the start of a class of an inability to attend the class he or she registered for will be able to transfer the deposit, minus a $75 registration fee, to another class within the next 6 calendar months OR may be transferred into the online course upon request. After the six month extension, all monies paid to 4YourCNA become forfeit and the student will be required to re-register.

Students who attend our class(es) may be viewed by other non-enrolled students, instructors, viewers, or the public who access the classroom via a live-stream connection. These classes may be broadcast to one or more of the following: social media channels, YouTube channel, website, online course or another digital platform. This release form is to make you aware of the broadcast nature of the classroom instruction. DO NOT ENROLL IF YOU OBJECT TO THESE TERMS. Live-streams may also be recorded and published for future viewing opportunities. In addition, students may occasionally be featured in video productions, print publications and/or public relations activities. This registration form indicates approval for your name, picture, art, written work, voice, verbal statements or portraits (video or still) to appear in videos, prints, or on our websites. For example, pictures and articles about school activities may appear in local newspapers or online publications. These pictures and articles may or may not personally identify the student. The pictures and/or videos may be used by our school in subsequent years.In order to guarantee your notification of these terms and ensure your agreement to participate, 4YourCNA requires that you sign this form.

Our school agrees that the student’s name, picture, art, written work, voice, verbal statements, portraits (video or still) shall only be used for public relations, public information, school promotion, publicity, and instruction. We have no control of media use of pictures/statements which are taken by other students without permission.

Student and Parent/Guardian understand and agree that:
• No monetary consideration shall be paid
• Consent and release have been given without coercion or duress
• This agreement is binding upon heirs and/or future legal representatives
• Photos, videos, or student statements may be used in subsequent years
• Agreement is required for classroom participation

BY SIGNING BELOW AND SUBMITTING THIS APPLICATION AND ASSOCIATED FEES, YOU ATTEST THAT ALL INFORMATION YOU HAVE PROVIDED IS CORRECT TO THE BEST OF YOUR KNOWLEDGE. CLASS SIZE IS LIMITED. ONCE PAYMENT HAS BEEN MADE, NO REFUNDS WILL BE GIVEN FOR ANY REASON.