Child Care Pre-Licensing Workshop Registration Form
Register for the Child Care Pre-Licensing Workshop by providing your contact details, session preferences, and any participation notes needed to coordinate attendance.
Registrant Information
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Workshop Registration Details
Workshop Session
*
Please Select
Licensing Orientation
Health & Safety Standards
Facility Readiness Review
Application Completion Clinic
Q&A / Open Session
Other
Preferred Workshop Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Registrant Role
*
Please Select
Owner
Director
Program Administrator
Lead Teacher
Operator
Prospective Licensee
Other
Child Care Program Name
Participation Notes and Confirmation
Accessibility or accommodation needs
Questions, comments, or special instructions
Confirmation
*
I understand this is a workshop registration and that the details I submitted should be accurate for attendance coordination.
Register
Should be Empty: