Empower Ability Healthcare Training LLC CBRF Training Registration Form

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Welcome , please fill out this form to register for CBRF courses. Your information will help us process your registration efficiently.

Full Legal Name *

Date of Birth *

Phone Number *

Email Address *

Home Address *

City, State & ZIP Code *

Which CBRF courses are you registering for? *

Standard Precautions

Fire Safety

First Aid & Choking

Medication Administration

All CBRF Courses

Required

Have you completed any CBRF courses before? *

Yes

If yes, which courses have you already completed?

Would you prefer distance learning for the courses that are available online? *

Yes

Either is fine

What days/times work best for your classes? *

Which payment option would you like? *

Special Offer: Pay $300 total for all four courses—one class FREE (ends August 31, 2026)

Pay separately before each course ($125, $125, $125, and $200

Pay the regular price of $575 in full

Are you registering for yourself or is an employer/agency paying for your training? *

Myself

Employer/Agency

Employer/Agency Name (if applicable)

How did you hear about Empower Ability Healthcare Training LLC? *

Is there anything we should know to help you with scheduling or registration? *

Do you need assistance finding employment after completing your training? *

I understand that submitting this form begins the registration process and that my class placement is not confirmed until I receive confirmation from Empower Ability Healthcare Training LLC.

Yes, I would like job-search assistance.

No, not at this time.

Acknowledgment & Agreement I understand that submitting this registration form does not confirm my class date until I receive confirmation from Empower Ability Healthcare Training LLC. I understand the CBRF training package is $300 total, with a $100 payment due before each scheduled course under the payment-plan option. I understand that eligible courses may be offered through distance learning and that Medication Administration requires in-person attendance. I understand that payments, attendance, and completion requirements must be met to successfully complete each course. *

I understand that submitting this form begins the registration process and that my class placement is not confirmed until I receive confirmation from Empower Ability Healthcare Training LLC.

I have read, understand, and agree.

Submit

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