Training Registration Form
Use this form to register for one of our upcoming training events. To register for FREE events Click Here.
*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?
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): *Fee:
Course/Workshop Title:
Course Number:
Date (s): Fee:
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. Registration accepted with payment only.
If you are unable to attend training, please call us so that those on a waiting list may enroll. CCC will issue a refund or credit if any training is full or cancelled.
1. By credit card (Note: This is not a secure form)
* Select Credit Card type Visa Master Card
*Card #:
*Name as it appears on card:
*Address of card holder:
*Expiration Date:
*3 Digit Security Code: Located on the back of your credit card.
2. By check or money order, print and mail registration form and payment 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 if you are paying by Credit Card. Submission of this form does not guarantee enrollment. If you are paying by check, print out this form and mail it to us with your payment. Registration accepted with payment only.
