Name: Teaching & Leading Children-For childcare providers only
Start: 2022-10-01T09:00:00-04:00
End: 2022-10-01T12:30:00-04:00
Location: The comfort of home!

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Personal Information
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EventRegistration
Name*
First Last
Are you a parent or guardian?*
- Parent
- Guardian
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Date of Birth*
MM slash DD slash YYYY
Race*
Ethnicity*
Gender*
Gross Annual Income*
How many people are dependent on this income?*
School District of Residence*
Will a parenting partner (spouse, partner, grandparent, aunt, or anyone who co-parents with you) be attending this class with you? If yes, please fill out Second Attendee information Section.*
- Yes
- No
Second Attendee Information
Name*
First Last
Is this person a parent or guardian?*
- Parent
- Guardian
Phone*
Email*
Date of Birth*
MM slash DD slash YYYY
Ethnicity*
Race*
Gender*
Gross Annual Income*
How many people are dependent on this income?*
School District of Residence*

Teaching & Leading Children-For childcare providers only

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Teaching & Leading Children-Sat 10/1/22

Step 1 of 2

Personal Information

Second Attendee Information

General Information

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