Online CDA Course Registration
Main Office Address: 840 SW 81st Avenue, North Lauderdale, FL 33068
Please Print Clearly and Return by: Friday, April 14, 2017
Name of Training:_CDA National Credential Training Course_ CEUs: 12 (120 hours)_
Location of Training: _Online_
Date: Starts May 1, 2017 – Anticipated ending on August 14, 2017 Time:N/A
Registration Fee:$50 Books: $110 Tuition: $1375 REGISTRATIONFEE IS NON-REFUNDABLE
Name:
Last 4 digits ofSocial 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) 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 _Friday, April 14, 2017__. You may FAX the registration form and call in a credit card payment to 954-724-3957.You may be eligible for a scholarship to assist you with the cost.
Please contact TEACH at a scholarship application or 1-877-358-3224.
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.
Online CDA Course Registration
Main Office Address: 840 SW 81st Avenue, North Lauderdale, FL 33068
Training Registration
ACKNOWLEDGEMENT
- 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!
- For more information on trainings, call Training Academy Hotline (954) 724-3957.
- Participants must be able to read, write and speak English, have access to a computer with basic audio/video output equipment, internet access (broadband recommended), and Microsoft Word and PowerPoint.
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:______