DAANC’s Registration Application

Dental Assistant Boot Camp Registration Application

First Name *

Last Name *

Date of birth *

Phone *

Email *

Street Address *

City

State

Country

Postal code

Are you currently employed? *

Yes

No

Are you currently looking for Employment? *

Yes

No

Place of Employment *

Office Phone

Office Address

Is your resume up to date? (Please bring a copy of your resume or your laptop)

Yes

No

What is the name of the Dental Assistant School that you attended? What date/year did you graduate? *

Today's skills status and expectations - List at least two treatments area/skills that you would like to work on or make better! Be as details as you'd like allowing us to BEST serve you! *

What is the outcome that you are expecting to walk away from by investing in this boot camp?

Signature -I have attached all documentation supporting my experience or classification as a Dental Assistant. *

Clear

Date Sign *

Select Course *

Dental Diva Boot Camp

This course is a comprehensive refresher designed for Dental Assistants eager to enhance their skills and elevate their chairside performance. Through a perfect blend of theory and hands-on practice, this boot camp will provide the knowledge and confidence needed to succeed in the fast-paced dental environment.

$9.99

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Office:

1001 E W.T. Harris Blvd #E

Charlotte, NC 28213

Call
(704) 201-9714

Email:

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