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Select a payment method below, and after you have paid, please return here and complete the registration form below.

Pay in Full

$2199

One-Time Payment

Pay Monthly

$833

For 3 Months(prior to start)

Pay Weekly

$459

For 5 Weeks(prior to start)

Registration Form

REGISTRATION INFO

NameEmail AddressPhone NumberAddress (please include City, State & Zip)Birthdate

EMERGENCY CONTACT

Emergency Contact 1PhoneRelationshipEmergency Contact 2PhoneRelationship

EMERGENCY INFO

Do you have any medical conditions or are you taking any medications that RADA should be aware of?Any Allergies?
Allergic to latex?
Anything else that your instructors should be aware of?

Refund Policy for Rexburg Academy of Dental Assisting

Cancellation greater than 1 month prior to class: Full refund minus $100 administration fee.

Cancellation less than 1 month prior to class: Full refund minus $100 administration fee and cost of CPR training, scrubs, and books (approx. $350).

Cancellation after one class period: $1500 refund.

Cancellation after two class periods: No formal refund, tuition may be deferred for 1-2 semesters.

I have read and understand the refund policy as explained above.

Thank you!

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