Training Academy
1415 W. Cypress Creek RD, Suite 103, Ft. Lauderdale, FL 33309
Training Registration– Please Print Clearly and Return by: Monday, July 31, 2017.
Name of Training: _Birth Through Five Florida Child Care Professional Credential and/or the CDA
National Credential Hrs/CEUs: 144 hrs/14.4 CEUs
Location of Training: 2915 East Tamarind Avenue, West Palm Bch, FL 33407
Date: Mondays and Wednesdays – August 7, 2017 – November 27, 2017 Time: 6:00 p.m. – 9:45 p.m.
Registration Fee: $50 Books: $110 Tuition: $1,375 REGISTRATION FEE IS NON-REFUNDABLE
Name:
Last 4 digits of Social Security #: XXX-XX- (required)
Address:
City/State/Zip:
Home Number: Cell Phone:
Email Address:
Employer:
Employer’s Phone #:
Employer’s Address:
City/State/Zip:
Employer E-mail address
Which best describes the age group that you work with most? CHOOSE ONE
Infant /Toddler (birth to 36 months) Preschool (3-5 years) School Age Children (5-11 years)
Please select 1 (one): FCCPC CDA National Credential
Please select 1 (one) Area of Specialization: Infant/Toddler Preschool Family Child Care Home
Payment Information: Please return this form with the $50 non-refundable registration fee to Family Central Training Academy at the above address by _Monday, July 31, 2017__. You may FAX or email the registration form 954-724-3957 or .
You may be eligible for a scholarship to assist you with the cost.
Please contact TEACH at www.teach-fl.org for a scholarship application or 1-877-358-3224.
Training Registration
ACKNOWLEDGEMENT
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 paid participants are allowed in class. Please read handbook for all course policies. Handbook will be reviewed on the first night of 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.
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.
Print Name:
Electronic Signature: Date:
Confirm Signature: ______Date:______
(PLEASE NOTE: Participant will be asked to sign this registration form upon the first day of class)
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 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.
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