Continuing Education Registration

Class Day	CODE	Class Description	Session 1	Session 2	Session 3	Cost
{{ $course->class_day }}	{{ $course->code }}	{{ $course->description }}	{{ $course->session_1 ?: '-' }}	{{ $course->session_2 ?: '-' }}	{{ $course->session_3 ?: '-' }}	${{ number_format($course->cost, 2) }}

REGISTRATION FORM / Registración

Full Name: {{ $registration->full_name }}

Title: {{ $registration->title }}

Email: {{ $registration->email }}

D.O.B.: {{ $registration->date_of_birth ? $registration->date_of_birth->format('m/d/Y') : 'N/A' }}

S.S.# XXX-XX- {{ $registration->ssn_last_four }}

Language: {{ $registration->language }}

Home: {{ $registration->home_phone }}

Work: {{ $registration->work_phone }}

Cell: {{ $registration->cellular_phone }}

Ethnicity: {{ $registration->ethnicity }}

Address: {{ $registration->address }}

City: {{ $registration->city }}

State: {{ $registration->state }}

ZIP: {{ $registration->zip_code }}

Module: {{ $registration->module }}

Start: {{ $registration->start_date ? $registration->start_date->format('m/d/Y') : 'N/A' }}

End: {{ $registration->end_date ? $registration->end_date->format('m/d/Y') : 'N/A' }}

Payment Information

TOTAL AMOUNT ${{ number_format($registration->total_amount, 2) }}

Fee: ${{ number_format($registration->fee, 2) }}
Shipping: ${{ number_format($registration->shipping_amount, 2) }}

Check #: {{ $registration->check_number }}
Money Order #: {{ $registration->money_order_number }}

Receipt #: {{ $registration->receipt_number }}

Credit Card #: {{ $registration->credit_card_number ? 'XXXX-XXXX-XXXX-' . substr($registration->credit_card_number, -4) : 'N/A' }}

EXP: {{ $registration->expiration_date }} CVV: {{ $registration->cvv ? 'XXX' : 'N/A' }}

Name on Card: {{ $registration->name_on_card }}

Billing Address: {{ $registration->billing_address }}

Acknowledgement

{{ $registration->acknowledgement_english ? 'X' : '-' }} I understand I am not registered for the upcoming certification exams.

{{ $registration->acknowledgement_spanish ? 'X' : '-' }} Yo reconozco que no estoy registrado para los próximos exámenes de certificación.

POLICIES / REGLAS

DRUG/ALCOHOL POLICY: Alcoholic beverages or other drugs, except those prescribed by a physician, are not permitted. WEAPON POLICY: Guns, knives and any other weapons are not permitted. LIABILITY RELEASE: At no time will the undersigned hold AATI or its representatives liable for any accident or injury. CAMPUS SECURITY, ACADEMIC INFORMATION RELEASE, FERPA, PHOTO RELEASE, RELEASE OF CERTIFICATION AND 16 HOURS of CONTINUING EDUCATION TO COUNTIES AND/OR EMPLOYERS apply. AATI reserves the right to cancel a course if a minimum of fifteen students is not met.

Signatures

Cardholder Signature:
@if($registration->cardholder_signature)

@endif

Student Signature:
@if($registration->student_signature)

@endif

Today’s Date: {{ $registration->today_date ? $registration->today_date->format('m/d/Y') : 'N/A' }} Initials: {{ $registration->initials }}

2026 CONTINUING EDUCATION & CERTIFICATION PREPARATION REGISTRATION FORM