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Family and Social Services Administration

Bureau of Child Care Home > Become a Child Care Provider > Licensed Homes > Register for Orientation Training > Register for Orientation Training 2 Register for Orientation Training 2

Complete the Following Form

* Denotes Required Field

 *Date Completed OT-1:

If you are enrolling for attendance at registered child care ministry training and have not attended OT-1, enter N/A.

 *Name of Facility:

 *Name of Religious Organization: (Registered Child Care Ministry Only, otherwise N/A)

*Address:

*City:

*State:

*ZIP Code:

*County:

*Phone Number:

*E-mail Address:

*Type of Training:

    Licensed Child Care Center
    Registered Child Care Ministry


*Are you currently operating a licensed facility? Yes No

If yes, are you planning to send staff for additional training? Yes No

Due to limited space, only two (2) persons per facility should attend.
For registered ministry training, it is encouraged that one attendee be the pastor of the church; the executive officer of a religious organization (e.g. YMCA, YWCA, parochial school).

Persons attending:

*Name:

*Title:

Name:

Title:


*Training Date You Wish to Attend:

*Please Select an Alternate Date:

This form must be received 10 days prior to the requested training date. You will receive a confirmation if the training date selected has available spaces; however, if the training date is full you will be notified to select another date.

Please check that all questions are answered. We can only process this pre registration application if all questions have been answered and OT-1 has been completed for licensed center training only. Thank you.