HCA Program Registration - Westsound Home Care
  • HCA Program Registration - Westsound Home Care

    Visiting Angels Kitsap
  • Please complete this form to register for the Home Care Aide (HCA) Certification Program at Westsound Home Care.

  • Format: (000) 000-0000.
  • Date of Birth
     - -
  • Do you have any prior caregiving experience?
  • How did you hear about the HCA Program at Westsound Home Care?
  • How will you be paying for your classroom tuition?
  • Which program schedule preference best fits your needs?
  • Clear
  • Addendum

    This Enrollment Agreement is between Westsound Home Care Training and:
  • Course or program title: DSHS Apprived 75 Home Care Aide Training Including Safety & Orientation

    The program consists of 4 (8 hour) classroom sessions plus approximately 43 hours of online training credit that must be completed by the student 120 days after the first day of class. The student’s file will be closed if the training is not completed within the required 120 days.
  • Start and Completion Date will be filled out by Westsound Home Care

  • Start Date
     - -
  • Expected Completion Date
     - -
  • Home Care Aide Training Fee Structure

    • Pay in full $650 plus $60.45 tax = $710.45
    • Payment plan $675 plus $25 registration fee plus $62.78 tax = $737.78
    • Students may choose to pay for the class over the 4-week training period.

    Payment plan details:

    • $287.78 due at registration
    • 3 payments of $150 due at the beginning of each week of class
  • Payment Method Preference
  • I understand that there is a 2.5% convenience fee added to all credit/debit card transactions         . Include billing address for Credit/Debit card

  • Other costs to become an HCA:

    • Washington State Department of Health Application Fee (Paid directly to the DOH) $100
    • State Certification Testing Fee (Paid directly to Prometric) $150
  • Agreement is Binding:

    This agreement will be binding only when it has been fully completed, signed, and dated by the student and an authorized representative of the school prior to the time instruction begins.


    Changes in the Agreement:

    Any changes in the agreement will not be binding on either the student or the school unless such changes are acknowledged in writing by an authorized representative of the school and by the student.


    Effective Date of Acceptance:

    I certify that I have read and understand the cancellation/refund policy and the complaint procedure.  I have received a copy of the brochure and I am entitled to an exact copy of this Enrollment Agreement, and any other papers I sign.


    Complaint Procedure:

    This school is licensed under Chapter 28C.10 RCW.  Inquiries or complaints regarding this private vocational school may be made to the:

    Workforce Board, 128 10th Ave. SW, Box 43105, Olympia, WA  98504

    Web: wtb.wa.gov

    Phone: 360-753-5662

    Email Address: wtecb@wtb.wa.gov


    Cancellation of Classes:

    The school reserves the right to cancel a starting class if the number of students enrolling is insufficient.  Such a cancellation will be considered a rejection by the school and will entitle the student to a full refund of all money paid if requested, or placement in the next available class with no refund.


    Cancellation and Refund Policy for Resident Training Programs:

    • The school must refund all money paid if the class is canceled by the school.
    • The school must refund all money paid if the applicant cancels within five business days (excluding Sundays and holidays) after the day the contract is signed or an initial payment is made, as long as the applicant has not begun training.
    • The school may retain an established registration fee of $25.00 for those students on the payment plan if the applicant cancels after the fifth business day of signing the contract or making an initial payment.  A “registration fee” is any fee charged by a school to process student applications and establish a student record system.
    • If training is terminated after the student enters classes, the school may retain the registration fee established under (3) of this subsection for those students on a payment plan.
    • If any student discontinues training after beginning the program the school will retain a percentage of the total tuition as described in the following table:
    If the student completes this amount of training: The school may keep this percentage of the tuition cost:
    One week 25%
    Two weeks 50%
    Three weeks 75%
    • When calculating refunds the following may be considered:
      • The official cancellation date will be considered to be the last day of recorded attendance; or
      • When the school receives notice of the student’s intention to discontinue the training program, or
      • When a student, without notice, fails to attend classes or,
      • When the student is terminated for a violation of a published school policy which provides for termination.
    • All refunds must be paid within thirty calendar days of the student’s official termination date.

    Notice to Buyer:

    Do not sign this agreement before you read it or if it contains any blank spaces.  This is a legal document.  All pages of this agreement are binding.  Read both sides of all pages before signing.  You are entitled to an exact copy of the agreement, our school brochure, and any other papers you may sign.  You are required to sign a statement acknowledging receipt of those.


    Cancellation of Contract:

    If you have not started training, you may cancel this contract by submitting written notice of such cancellation to the school at its address shown on the contract, which notice shall be submitted not later than midnight of the fifth business day (excluding Sundays and holidays) following your signing this contract or the written notice, the burden to prove services rests on the sender.


    Replacement Cost of Certificates:

    A fee of $25 will be required to replace any damaged or lost certificates


    Unfair Business Practices:

    It is an unfair business practice for the school to sell, discount, or otherwise transfer this contract or promissory note without the signed written consent of the student or his/her parent or guardian if he/she is a minor and a written statement notifying all parties that the cancellation and refund policy continues to apply.

     

  • Clear
  • Date
     - -
  • As the authorized representative of the school, I hereby agree to the condition set forth herein:

  • Clear
  • Date
     - -
  • Should be Empty: