Specialty Training Application

S&H Training Center, Inc.

504 Union Ave SE
Olympia, WA 98501
Additional Skill Location in Vancouver

sarah@sandhtraining.com

www.sandhtraining.com

(360) 539-7423
Dementia Level 2 Application

Please note: To sign up for this class you will have needed to complete the Dementia Level 1 training.
Name:*

First NameMiddle InitialLast Name
E-mail Address:*
example@example.com
Cell Phone Number:*
Format: (000) 000-0000.
YesNo
Employer Name
Employer Contact
Contact Email
Contact Phone Number
YesNo - You will NOT receive class reminders
Mailing Address (where workbooks will be mailed to):*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date:*

MonthDayYear
Date
YesNo. If no, you must pass an English and math test before enrolling in classes.

NO SHOW POLICY:

A no show fee of $20 will be charged to any student who misses a class they are registered for without CANCELLING/RESCHEDULING in advance. This fee will need to be paid before attending any future classes.
I agree to the No Show Policy.
Signature*

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Dementia Level 2
Dementia Level 2 Class on Zoom on September 17, 2025.

$110.00

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

NO SHOW POLICY: