1415 West Cypress Creek Road, Suite 103, Ft. Lauderdale, FL 33309

Training Registration– Please Print Clearly

Name of Training: How To Become A Quality Child Care Center_Workshop_Hours/CEus:2-Hours/ 0.2 CEUs

Date:_Thursday, August3rd, 2017_ Time:_ 6:30 pm – 8:30 pm __ Cost: _____FREE______

Location of Training:_Sunrise Village Civic center- 6800 Sunset Strip, Sunrise, FL 33313_

Participant’s Name:

Social Security #: XXX-XX-

Address:

City/State/Zip:

Phone Number

Cell Number:

Email Address:

Employer:

Employer’s Address:

City/State/Zip:

Employer’s Phone #:

Employer Email:

Please send completed registration form and payment toFamily Central Inc. Training Academy at the above address. You may also email it to or fax to 954-724-3957.

PROPRIETARY INTEREST DISCLOSURE

Family Central, Inc. does not support, condone, or encourage the departments offering training events, to contract with instructors who may have a commercial interest in any products or services mentioned during the course of the event.

Such departments are highly advised and encouraged to utilize the training skills and knowledge of current employees throughout the agency.

As much as possible, training materials should be generic in nature. Materials provided free of charge by the Agency for Workforce Innovation, Department of Children and Families, Department of Health, Department of Education, or other such related governmental agencies or non-profit organizations, should be utilized.

The Training Academy Manager or department Program Administrator is responsible for approving all training content and materials. Should the training reference a specific product, material, instrument, or service, the Training Academy Manager or Program Administrator is accountable for ensuring that the instructor either has no proprietary interest or makes a full disclosure.

Family Central, Inc. reserves the right to dismiss any instructor who fails to make a full disclosure regarding proprietary interest with regards to any aspect of a training event.

In the unlikely event that an instructor does have proprietary interests and is still contracted to conduct a training or workshop, this information will be communicated to prospective participants prior to the start of the program through promotional avenues.

I hereby acknowledge that the information I am sharing with Family Central Training Academy can and may be shared with state and local agencies for the purpose of seeking scholarship dollars.

  1. Your space in the class is not guaranteed without this form and payment. Please make payment to Family Central Training Academy at the above address. DO NOT MAIL CASH! Mail-in registration must be received by date above. Family Central, Inc. will not be responsible for lost or delayed documents. It is the responsibility of the participant to call and verify receipt of registration. If the class is full, you will be notified. Registration fees are non-refundable. Save receipt for proof of payment. Money orders, credit cards or company checks only! No personal checks please!
  2. Children, friends and family members are not permitted in any training session. Only pre-registered participants are allowed in class.
  3. For more information on trainings, call Training Academy Hotline (954) 724-3957.
  4. Participants must be able to read, write and speak English.

Electronic Signature:Date

Confirm Signature:______Date______

2014 Family Central, Inc.

TA 08/29/2014