Nursing Assistant Re-Registration Form

First name*

Last name*

Email*

Phone*

Original Class Details*

Reason for Re-Registration:*

New Class Details*

Alternative Class Start Date:*

Special Circumstances:

Supporting Document Upload

Agreement and Signature

I understand that my $99 non-refundable deposit will be transferred to the new class date once, provided I meet the notification requirement. If I fail to attend the re-scheduled class, the deposit will be forfeited, and a new deposit will be required for any subsequent re-registration. I agree to adhere to the terms and conditions set forth by Bell Healthcare Training School.

Signature*

Date*

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