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Complete the Following Form
* Denotes Required Field
*Date Completed OT-1:
If you are enrolling for attendance at registered child care ministry training and have not attended OT-1, enter N/A.
*Name of Facility:
*Name of Religious Organization: (Registered Child Care Ministry Only, otherwise N/A)
*Type of Training:
*Are you currently operating a licensed facility? Yes No If yes, are you planning to send staff for additional training? Yes No Due to limited space, only two (2) persons per facility should attend.For registered ministry training, it is encouraged that one attendee be the pastor of the church; the executive officer of a religious organization (e.g. YMCA, YWCA, parochial school).Persons attending:
Title: *Training Date You Wish to Attend: Dec. 4, 2013 Jan. 8, 2014 Feb. 5, 2014 March 5, 2014 April 2, 2014 May 7, 2014 June 4, 2014 July 2, 2014 Aug. 6, 2014 Oct. 1, 2014 Nov. 5, 2014 Dec. 3, 2014 *Please Select an Alternate Date: Dec. 4, 2013 Jan. 8, 2014 Feb. 5, 2014 March 5, 2014 April 2, 2014 May 7, 2014 June 4, 2014 July 2, 2014 Aug. 6, 2014 Oct. 1, 2014 Nov. 5, 2014 Dec. 3, 2014
This form must be received 10 days prior to the requested training date. You will receive a confirmation if the training date selected has available spaces; however, if the training date is full you will be notified to select another date.
Please check that all questions are answered. We can only process this pre registration application if all questions have been answered and OT-1 has been completed for licensed center training only. Thank you.
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