Name:

Telephone:
(home) (work)

Address:

Email address:

Professional background:

Provide a brief summary of your professional work/training experience:

I am a certified trainer for the following training programs:
Kid's Time
Family Child Care At It's Best
Program for Infant Toddler Caregivers (WestEd)
Including All of Us
Mentor Training
High Scope
Child Care Provider Health & Safety (EMSA)
Second Helping
Immunization Assessment
Other
Other

I currently provide training in the following areas: (please choose a maximum of 3 items)

Infant/Toddler Preschool School Age Middle School Special Needs Health & Safety Child Abuse Parenting Professional Development Brain Development	Guidance Curriculum Diversity Conflict Resolution Staff Development Family Child Care Accreditation Program Administration Adolescents Literacy School Readiness
Other(s):

Thank you for helping YMCA CRS increase training opportunities for child care providers in San Diego County!

Please remember to also submit a Training Information Form for each training topic that you offer.