REGISTRATION FORM

WE ACCEPT CASH, DEBIT/CREDIT CARDS, CASH APP, CASHIER'S Checks & MONEY ORDERS. ONLINE PAYMENTS CAN BE MADE via PAYPAL (top of the page). Here are a list of ways you can pay your tuition:

1. pay in full

2. Apply for PayPal credit - Click below to apply for Paypal credit.

3. set up weekly/biweekly payment installments with our CNA program

(after the initial payment is made).

4. Cash App: cash.me/$CNAPROGRAM

5. Qualify for the Georgia WIOA Public Assistance Student CNA Program (see below)

**EMAIL US TO REQUEST A PROXY CAREGIVER CLASS TWO WEEKS IN ADVANCE. NO REFUNDS.

** STAFF OF THE CNA PROGRAM CANNOT RECEIVE REFERRAL COMPENSATION.

Email: *

Apply for Credit

Please complete the registration form below and click SUBMIT. Then click on the "yellow Add to Cart" button at the top of the page and you will be directed to pay your registration fee and the minimum down payment for the class you are registering for. If the fees are not paid with your form, your registration is incomplete.

REGISTRATION FORM

CLASSES ARE HELD AT 600 EISENHOWER PKWY.

(MACEDONIA BAPTIST CHURCH, ANNEX BLDG.)

MACON, GA. 31206

P/F: (478) 742-5230

EMAIL: visionpch2008@yahoo.com

I Understand I Must Pay the Registration Fee & minimum down payment for the class i'm registering for. *

Yes

Do you receive public assistance? If so, choose which one below applies to you.

Phone *

Full Name: *

Zip Code *

City *

Which class are you registering for? *

Option 1: In-Person CNA

Option 2: Blended CNA (Online & In-Person)

Option 3: Proxy Caregiver Training (for PCHs Only)

Option 4: Certified Medication Aide (CMA) (must be a Ga registered CNA already)

Street Address (and Apt. #, if applicable) *