RoCo Early Childhood Academy Registration
Please be aware that signing up does not guarantee acceptance into the academy. This is a waitlist aimed for individuals who have no prior experience in early childhood, but would like to get started and aim to work at a child care center in Rockingham County. You will be notified once we have a date for our next academy. All of your answers in this form will be considered during the selection process for our next group of academy students. 

For questions contact Marilyn Bernabe at marilynb@rockinghamkids.org or call 336-342-9676 ext. 209. 
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Email *
First & Last Name 

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Phone Number

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Do you require any accommodations? 

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If yes, what accommodations can we provide? 

What is your race? 

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What is your zip code of residence? 

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What is your age range?

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Are you bilingual? If yes, what is your second language besides English? *
Do you have any food allergies? 
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If yes, what are your food allergies?
How did you hear about the academy? *
I understand that this is an intensive two week academy with a registration fee of $40 that is non-refundable and must be paid prior to the start of the academy. My full participation and attendance is required for the two weeks in order to graduate from the academy.  *
As a way to meet requirements we will need to visit local agencies such as: Sheriffs Dept., Health Dept., and our community college as a group. Are you willing to drive or carpool with someone? 
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Are you currently employed in a licensed child care center? If yes, please state the name of the center.  *
Why would you like to join the academy?  *
I grant permission to Rockingham County Partnership for Children to use my image (photographs and/or video) for use in any media publications.  *
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