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Jan 2023-Registration form
Trainer: Sobia Khan
Jan 13th 6:00- 7:45 PM Orientation Night
Jan 14th, 15th, 21st, 22nd, 28th, and 29th full Days of training from 8 AM to 4 PM.
Cost: $400/ person
Sobia@coloradochildcareconsulting.com
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Email
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Your email
I am filling out this form for my self or on behalf of some one with their permission. The person attending, acknowledges the dates and times of this training.
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Yes
Participant's First Name
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Your answer
Last Name
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Your answer
Personal Cell Phone Number
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Your answer
Job Title (Please check all that apply)
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Administrator
Teacher
Childcare Provider
Family Member
Early Interventionist
Service Coodinator
ECSE
Service Provider(SLP,OT,PT)
Licensing Agent
Consultant/Coach
Trainer/TA
Quality Rater
Health Provider
Foster Parent
Faculty
Other:
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Affiliation (Please check all that apply)
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Childcare Center
Family Childcare
School District/BOCES
Early Childhood Council
Resource and Referral
Early/Head start
State Agency
Mental Health
Higher Education
Child Welfare System
Public Health/ Health care
Other:
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What ages do you work with?
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Infant( 0-12m )
Toddler ( Ages 12m -24 m)
Toddler (Ages 2 yr -3yr)
Preschool ( 3yr-4 yr)
Prek ( 4-5)
Floater/ Admin
Adult
Required
Center / Agency Name
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Your answer
Center / Agency Phone
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Your answer
Director's Name ( If applicable)
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Your answer
Agency / Director Email
Your answer
Center / Agency Address: Street
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Your answer
City and Zip code
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County
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Your answer
How did you hear about this training?
Your answer
Attendance Policy: As per effective Oct 2021 guidance of Pyramid Colorado, in extreme circumstances, a participant may miss 2 sessions, participant must make up the missed sessions within 6 months of the last training session of the series. To receive a certificate of attendance participant must complete ALL 18 sessions. Participants will need to re-enroll in a new training if they miss more than 2 sessions of training.
I verify that I have access to a computer with audio and video capability. (Please don't sign up if you don't have a camera on your device). I have verified that the training dates works for me. I know that the payment is non-refundable.
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Yes
How would you like to pay for this training? We offer many trainings, for proper processing, please put
your
full name and training name in the payment notes.
for example "Jane smith, Oct Pyramid training"
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Zelle: Set up Sobia Khan and my phone number 303-807-2525
Venmo: My ID is @coloradochildcareconsulting (Add $10 fee per person)
PayPal: My PayPal ID is:
https://paypal.me/LETSDOPPA?locale.x=en_US(Add
$10 fee per person)
Please email to confirm with me before you fill out this form. The class gets full very quickly, Sending the payment first is not a guarantee of confirmation. Please let me know how / who will be making the payment. You are registered once, I receive this form and the payment. Please contact me:
Sobia@coloradochildcareconsulting.com
with any questions.
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Yes, I have contacted Sobia before submitting this form with payment information.
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