*First Name:        

*Last Name:        

*Address:        

*City:            *State:        

*Zip Code:          

*Home Phone:                                     

Email:

Employer:

Work Phone:  

Fax:  

Position:

*Please choose at least one of the following that applies to your position.   Select at Least One Family Child Care Group Child Care: Infant/Toddler Group Child Care: Preschool Group Child Care: School Age Public School Parent Other

Do you have a college degree?

No    Yes                                

If Yes, type of degree: Select One Associates Bachelors Masters Doctorate

Are you enrolled in college?

No     Yes

Are you pursuing EEC qualifications? (i.e. Teacher, Lead Teacher, Director) No    Yes

Are you pursuing the CDA (Child Development Associate)?  No    Yes

Family Child Care Systems and Group Child Care programs may register up to two (2) staff per training. If you would like to enroll additional staff or providers into any training, contact CCC at training@cccfscm.org to inquire about available spaces. 

*Course/Workshop Title:          

*Course Number:          

*Date (s):          

Registration Options:

If you would like to receive a registration confirmation please email us at mail@cccfscm.org. Weather cancellations are available on our weather/emergency line by calling 1-800-278-1503 ext 31. If training is cancelled due to weather, you will be automatically registered for the snow date published by CCC. No refunds or credits will be available.  

If you are unable to attend training, please call us so that those on a waiting list may enroll.

1. Press Submit below.

2. or print and mail registration form to:

FSCM/Child Care Connection                                 100 Grove Street, Suite 115                         Worcester, MA 01605                                           Attn: Training Registration

3. By fax, print and fax form to 508-849-2089 with credit card information filled out.  

4. Drop In to Child Care Connection, address above.

Thank you for taking the time to complete this form. Please click the Submit button to attend this FREE training. Submission of this form does not guarantee enrollment. If you are registering for a training that requires payment please Click Here for the appropriate registration form.