Seven Hills Foundation | Children's Aid & Family Service

Children's Aid & Family Service

Child Care Resources Registration Form
Printable Version (Opens in New Window)

Please use this form to register for individual workshops, orientation, CEU series, First Aid and CPR.

General information about registration for workshops

Pre-registration is required for all workshops.
All registration forms must be accompanied by payment, unless using purchase order.� Use 1 registration form per person.
Space in workshops cannot be held without
registration and payment.
All registration fees are non-refundable.
You will be contacted only if your registration is not accepted.� All others should assume confirmation.
Child Care Resources reserves the right to cancel workshops due to insufficient enrollment.
Child Care Resources reserves the right to cancel workshops at our discretion.
Child Care Resources reserves the right to limit enrollment according to our training policy.

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PLEASE FILL OUT FORM COMPLETELY. COPY AND USE SEPARATE FORMS FOR EACH REGISTRANT. PLEASE PRINT INFORMATION.

Please Print:

Name:____________________________________________

Home Phone:_____________________________________

Home Address:___________________________________

City:_____________________________________________

State:________________ Zip:________________________

Work Place:______________________________________

Work Phone:______________________________________

JOB TITLE (Please Check One):

Are you enrolled or have? (Please check all that apply)

College Degree

In a Degree Program

CDA Program

ABE/ESOL Program

Pursuing EEC Certification

Does your program belong to a Community Partnership?

Yes No I don't know

If Yes, please indicate CPC Name: ___________________

WORKSHOP REGISTRATION

Training Title Date Fee

__________________________ ___________ _______

Payment:
Providers have the option of paying by check, VISA or MasterCard.

	Check enclosed payable to Child Care Resources
	VISA
	MasterCard
Name (as on card):________________________________
Signature: _______________________________________
Address (if different from registrant): ________________________________________________
Card #:__________________________________________
Expiration Date:___________________________________
	CPC, Agency or System paying.
Name of Payer: ___________________________________
Purchase Order #:_________________________________
Are you interested in holding future trainings at your site?
	Yes	No
Please mail completed form and payment to: Child Care Resources 76 Summer St. Suite 345 Fitchburg, MA 01420

Children's Aid & Family Service

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