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Home Care Basics Registration Form
This form is to register for the BVI Red Cross Home Care Basics training. Because of limited space, once you have completed and submitted this form, please report to the BVI Red Cross and pay a deposit of $250.00 to secure your space in the class.
Name of Applicant
Please state your gender
Male
Female
Prefer not to say
Date of birth
MM slash DD slash YYYY
Mobile Phone Number
Secondary Phone Number
Current Physical Address
Education
Primary
Secondary
Community College (Associates degree)
Higher Education (Bachelors')
Trade School
Status
Belonger
Resident
Work Permit
Exemption
Visitor
Do you have any previous experience working with the elderly?
Yes
No
Third Choice
Do you have any previous training in care of the sick or elderly?
Yes
No
Third Choice
If yes, which organization or institution did you complete your training with?
NAME OF NEXT OF KIN( In case of emergency)
Telephone Number
Consent
I hereby declare that the information provided in this application is true and that by completing this application,it does not gurantee that my application has been approved.