NEBDN Dental Nurse Course Registration form

Course CourseNEBDN National Diploma in Dental NursingDental Radiography (only if you are already qualified as a NEBDN Dental Nurse)Oral Health Education (only if you are already qualified as a NEBDN Dental Nurse)Fluoride Varnish Application (only if you are already qualified as a NEBDN Dental Nurse)

Title TitleMrMrsMiss

First Name (as it appears on your passport)

Last Name (as it appears on your passport)

Email Address

Phone Number

WhatsApp number (If you don't have one, you must download it)

Date of Birth

Full Address including Post Code

Nationality

Are you currently working as a Dental Nurse? Are you currently working as a Dental Nurse?YesNo

Name of the Clinic

Part Time or Full Time Part Time or Full TimeFull TimePart Time

Do you have a criminal record? Do you have a criminal record?YesNo

Education (Name of School/College/University)

Work Experience

Are you allowed to live and work in the UK? Are you allowed to live and work in the UK?YesNo

Do you require a work permit or visa to work in the UK? Do you require a work permit or visa to work in the UK?YesNo

Do you have a National Insurance Number? Do you have a National Insurance Number?YesNo

Your National Insurance Number

How did you hear about us? How did you hear about us?James & J ConsultancyDental Hygienist Advisory BoardOther

Declaration Declaration I accept to pay monthly course fees every month, 150 per month, regardless if I am currently working or not. I accept to pay extra course fees if I need to extend the course longer than June 2023, meaning if for any reason you want to extend the course, then the monthly fee of £100 per month will be applied as well as any exam deferral or re-sit fees or any other NEBDN admin fees. (This includes not being prepared for exam, failing the exam, requesting to take the exam later), I understand that if I don't pay monthly fees every month, my course will be discontinued. I understand that finding and securing trainee dental nurse placement takes 3-6 months. I understand that Dental Tutors do not provide any guarantees in finding a placement. I understand that any fees paid to Dental Tutors are non-refundable. I accept to pay the exam fee of 485 in one full payment as soon as I start working as a trainee dental nurse. I declare that I have completed this application truthfully and to the best of my ability.