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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: Oct. 1, 2014 Nov. 5, 2014 Dec. 3, 2014 Jan. 7, 2015 Feb. 4, 2015 Mar. 4, 2015 Apr. 1, 2015 May 6, 2015 Jun. 3, 2015 Jul. 1, 2015 Aug. 5, 2015 Sep. 2, 2015 Oct. 7, 2015 Nov. 4, 2015 Dec. 2, 2015
*Please Select an Alternate Date: Oct. 1, 2014 Nov. 5, 2014 Dec. 3, 2014 Jan. 7, 2015 Feb. 4, 2015 Mar. 4, 2015 Apr. 1, 2015 May 6, 2015 Jun. 3, 2015 Jul. 1, 2015 Aug. 5, 2015 Sep. 2, 2015 Oct. 7, 2015 Nov. 4, 2015 Dec. 2, 2015
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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