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. Use 1 registration form per person.
• All registration forms must be accompanied by payment, unless using purchase order.
• 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 at our discretion, i.e., insufficient enrollment.
• Child Care Resources reserves the right to limit enrollment according to our training policy.
• CHILDREN WILL NOT BE ALLOWED. THERE IS NO ONSITE BABYSITTING.

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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:___________________________________

Town:_____________________________Zip:___________

Work Place:______________________________________ 

Work Phone:______________________________________ 

JOB TITLE (Please Check One):

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

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.

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81 Hope Avenue, Worcester, MA 01603  Tel 508.755.2340  Fax 508.849.3882  TTY 508.890.5584
Copyright © 2006 Seven Hills Foundation. All Rights Reserved.