Childcare Training Registration Form

Instructor:   Althea Penn, Educational Consultant

Bright from the Start DECAL approved trainer/training

Website:  http://altheapenn.tripod.com 

E-mail:  penntraining@bellsouth.net

678.557.8684

 

Please print and complete all information.

NAME OF CENTER/SCHOOL/primary attendee: ________________________________________________________

 

Center OR Attendee STREET ADDRESS:_________________________________________________ CITY ________________________ 

 

ZIP _____________ PHONE NUMBER:_____________________FAX NUMBER:__________________  E-MAIL ______________________

 

Type of Center:  SCHOOL/Center based  ___ Group Day Care ___  Family Day Care___  WEBSITE _______________________________

Attendees

 

 

 

Name (Last, First)

 

 

Social

Security

Number

Type of

Registrant

Owner, Director,

Lead Teacher,

Assistant Teacher,

other

 

 

Years

Exp.

Age Group

Infants,

Toddlers, Preschool,

Kindergarten, or School Age

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Healthy & Happy Children SESSION (Indicate sessions with a check)

6 hrs. of Bright from the Start required health and safety training:  This workshop provides knowledge and multi-sensory learning experiences.  Recognizing common childhood illnesses; Recognizing child abuse/neglect and reporting requirements; and indoor/outdoor safety procedures

ü

Session Titles

Date/Time

Location

Adv.

Reg.

Reg.

onsite

# of

Atten

-dees

Amt

Due

 

Healthy & Happy Children

 

 

$40

$50

 

 

 

Healthy & Happy Children

 

 

$40

$50

 

 

 

Onsite Training

 

Contact trainer…

 

 

 

 

Please sign below after reading the following important information:

I understand that all registration fees are nonrefundable; however they may be transferred with prior approval (a minimum of two days prior to the training date).  The advance registration deadline is fourteen business days prior to the training.  Please be advised that onsite registration is not guaranteed, space is limited.

Discounts:  5% discount for groups of five or more participants (must pre-register)

Mail the completed registration form (white copy) along with a check or money order to:

 

Althea Penn, Educational Consultant, P. O. Box 49254, Atlanta, GA 30359

 

Photocopy as needed. Questions? Please call the training registration center at 678.557.8684

 

Signature ___________________________________    Date _____________   Check or m.o. # ______________________