Event Registration

POWERFUL INTERACTIONS SERIES (3 DAYS; 10 HOURS Certificate)

This course consists of 3 sessions from May 14th to May 20th

First Name:

Last Name:

Email:

Phone:

Phone (Text): Phone Number that can receive text messages (if different than your main number)

ACS ID Number:

Address

Address:

Apartment:

City:

State / Zip:

Sessions

Session Select Instructions

You will be registered for the following sessions.

POWERFUL INTERACTIONS (Part 1-Being Present): Tuesday, May 14th 10:00am - 12:00pm

POWERFUL INTERACTIONS (Part 2- Connecting with others): Saturday, May 18th 10:00am - 12:00pm

POWERFUL INTERACTIONS (Part 3- Extending Learning): Monday, May 20th 10:00am - 12:00pm

Provider Status / Employment

Status:

Role / Position:

Do you belong to a Family Child Care Network*?

*A Family Child Care Network (FCCN) is an agency or organization that refers and enrolls children in your program, and provides other support. An FCCN is not ACS or other organizations where you have participated in training. If you are in a FCCN, you are not eligible to participate in our training at this time. You can find a list of Family Child Care Networks here.

Total Count of Children in Care

Count of Infants (birth - 3yrs)

Count of Toddlers (3yrs - 5yrs)

Count of Preschoolers (5yrs - 8yrs)

Count of School-age Children (8yrs - 12yrs)

Relationship to child/children in care

Photography and Video Release Acknowledgement

I acknowledge the below photography and video release statement.

I hereby authorize the New York Early Childhood Professional Development Institute (The Institute) under the auspices of The Research Foundation of the City University of New York (CUNY) to take and use photographs of me in connection with the above-identified event. I authorize The Institute/CUNY, its assigns, and transferees to copyright, use, and publish the photographs in print and/or electronically.

I agree that The Institute/CUNY may use such photos of me with or without my name for any lawful purpose, including but not limited to publicity, illustration, advertising, and web content.

I understand that this event may be recorded and shared online. Any questions asked or comments offered over audio or entered in the chat box may be included in the recording.

I have read and understood the above.

How did you hear about this class

Select*:

CUNY Campus: Which CUNY campus did you learn about us from?

SUNY Campus: Which SUNY campus did you learn about us from?

Other / Detail: (optional)

Have you ever participated in training with the Informal Family Child Care Project?