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CHILDCARE ASSOCIATION OF LOUISIANA 2016 FALL EDUCATION CONFERENCE

All Sessions have been linked to CLASS (Classroom Assessment Scoring System) which is a tool used to measure teacher effectiveness as well as TS GOLD (Teaching Strategies GOLD) a child assessment tool used to measure and improve school readiness for young children!

PRE-REGISTRATION PACKET

FRIDAY, OCTOBER 14, 2016 SATURDAY, OCTOBER 15, 2016 WEST BATON ROUGE CONFERENCE CENTER

2750 NORTH WESTPORT DRIVE PORT ALLEN, LOUISIANA

For more information, contact Cindy Bishop, Executive Director

cindy.bishop@checkmate-strategies.com or (225) 933-5435

If you have not renewed or joined for 2016 – do so now at ½ off for 2016.

Offer good through October 15, 2016! Your center must be a CCAL Member in order to the conference! Contact our Membership Director, Sarah Heath to find out how!

sarah.heath@checkmate-strategies.com or (225) 326-3180

CCAL membership fees are based on licensure capacity

Small Center

1 - 99 $120 Join Now for

$60

Medium Center

100 - 199 $165 Join Now for

$82.50

Large Center 200 or more

$200 Join Now for $100

Download a membership application from the CCAL website or email

sarah.heath@checkmate-strategies.com and request a membership application from our office!

www.childcarelouisiana.org

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GENERAL SESSION FRIDAY, OCTOBER 14, 2016

8:45 A.M – 9:00 A.M Welcoming Remarks

Jonathan Pearce, President Childcare Association of Louisiana

9:00 A.M – 10:00 A.M. KEYNOTE SPEAKER

Dr. Michael Gaffley ~ Understanding the Relationship between Personal Values and Professional Policies and Procedures

10:00 A.M-11:00 A.M Louisiana DOE Updates

Jenna Conway, Assistant Superintendent Shelia Campbell, Director of Licensing

-Unified Rating System and Program Profiles -Comprehensive Professional Development Supports for Child Care including Reimbursement for Quality Curriculum -Teacher Preparation and Supports for Earning an Early Childhood Ancillary Teaching Certificate -Continued Progress towards Coordinated Enrollment and Funding

11:00 A.M.-12:00 P.M. Louisiana Labor Updates

Troy Mouton, US Department of Labor

Robert J. Roux, Executive Counsel, LA Workforce Commission

FSLA and Overtime Overhaul: Preparing for the New Rule

State Law Update

12 P.M. -1:15 P.M. Luncheon with Sponsors & Door Prize Giveaways

Tafta Miller, Vice President

Childcare Association of Louisiana

Each SPONSOR will introduce themselves and speak about their products during this time.

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FRIDAY AFTERNOON BREAKOUT SESSIONS OCTOBER 14, 2016

All Sessions have been linked to CLASS (Classroom Assessment Scoring System) a tool used to measure teacher effectiveness as well as TS

GOLD (Teaching Strategies GOLD) a child assessment tool used to measure and improve children’s readiness for school!

SESSION A 1:30 – 4:30 PM

Cognitive

Development & A Loving

Environment

Amanda Rideaux

SESSION B 1:30 – 4:30 PM

Utilizing Inner

Strength to Enhance Leader

Effectiveness

Dr. Michael Gaffley

SESSION C 1:30 – 4:30 PM

Growing Leaders

Gina Carter VOA Partnerships

in Child Care

SESSION D 1:30 – 4:30 PM

More Than

1, 2, 3: The

Fundamentals of Math for

Preschoolers

Kim Duncan

SESSION E 1:30 – 4:30 PM

Marvelous

Manipulatives: Tools for Learning (CDA 2)

Nancy P. Alexander

SESSION F 1:30 – 4:30 PM

Medication

Administration

Dianna Constant Agenda for Children

SESSION A: Cognitive Development & A Loving Environment with Amanda Rideaux

This course offers a brief description of Piaget’s Theory of Stages of Cognitive Development. Then a detailed account of the 5 Love Languages of

Children will be discussed.

Amanda Rideaux has a Bachelor of Arts degree with a concentration in Public Relations and a minor in Spanish from the University of Louisiana in Lafayette. She has also taken courses at ULL to complete the Alternate Path Certificate in Early Childhood Education. Amanda has completed the Early Childhood Development Diploma Program in 2014. She has over eight years of experience in the child care industry. She is certified CPR/First Aid trained and also completed National Administrator Credential Course for child care center Directors. She recently became a Pathways Approved Trainer for the state of Louisiana as was also issued her Ancillary Teaching Certificate in 2016. Amanda can be reached at amanda_hb@hotmail.com

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SESSION B: Utilizing Inner Strength to Enhance Leader Effectiveness with Dr. Michael Gaffley Leaders, managers and supervisors have to work with and through other people to achieve the organizational mission. Training alone does not change organizations; changed people change organizations. Stagnant people have difficulty making sense of change and leading organizational transformation. Come learn how to lead through your personality type.

SESSION C: Growing Leaders with Gina Carter

In this session Early Childhood Educators will discuss strategies to grow good teams of teachers, including rapport building and ways to provide specific feedback to support improved practices.

Dr. Michael W. G. Gaffley CYC-P is program professor and graduate of Nova Southeastern University and is a certified professional development specialist. He teaches courses in Human Resource Development, Human Resource Management, Leading Change, Diversity and Ethics. He is a Florida DOE certified clinical educator. He is adjunct professor for the John Scott Dailey Florida Institute of Government at FAU. He facilitates capacity building in national programs such as Head Start and Community Action Agencies. He is one of the founding members of the Black Heritage Council and is proficient in the art and science of paradigm shifts, relational education and lifestyle Central Academy in Palatka, FL. He directed intervention work with sexually negotiations in diverse contexts. He is a certified Child and Youth Care Practitioner (CYC-P). He is CLASS reliable. He is a board member of the, physically and emotionally abused children and youth, as well as with foster care and socially excluded families in high risk environments. He is a former executive director of state and human services agencies in South Africa where for more than twenty years he was a driving force in many collaborative community based partnerships. Dr. Gaffley can be reached at dtbc@cultureal.com

Gina Carter began her career in the early childcare industry the same way that many of you have. She had a passion for children and wanted to be more involved. So she applied to work at a child care center. She was hired as a two year old teacher and given minimum training and set loose. She was promoted to an Assistant Director, Director, trained as an ERS assessor (Environment Rating Scales) conducted assessments, observed classrooms, and now she provides training, assistance, and support to Early Childcare Centers. Additional training and certifications include: Affiliated Trainer for Toddler and Pre-K CLASS (Classroom Assessment Scoring System) tool as well as a reliable observer for the Infant CLASS tool. Train the Trainer for TS GOLD (Teaching strategies GOLD) which is a child assessment tool on child growth and development. Over the years she has attended many classes, trainings, studied under many wise people, learned and unlearned a great deal. She thinks what she has learned the most is that things change and we must also be in a constant state of change. But this basic principle remains constant in guiding her philosophy. Look through the eyes of a child, See what they see, Feel what they feel, and be compassionate to it. Gina may be reached by email at gcarter@voagbr.org

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SESSION D: More Than 1, 2, 3: The Fundamentals of Math for Preschoolers with Kim Duncan Learn how to create a math-rich classroom that encourages curiosity and a healthy math attitude. By using the Early Learning and Development Standards as a guide teachers can intentionally take advantage of children’s natural curiosity, make the most of their interactions with students, and create great opportunities for assessment

SESSION E: Marvelous Manipulatives: Tools for Learning (CDA 2) with Nancy P. Alexander Learn how your teachers can get the most from the many table toys your center has. Find out how your teachers can use specific manipulatives to meet the Early Learning and Development Standards and how to interact with children to provide instructional support as assessed by CLASS.

SESSION F: Medication Administration with Dianna Constant Administration of Medications to Children in Child Care Facilities provides a mechanism for administering medication to children in child care facilities. This policy specifically establishes the procedures to follow in order to institute a clear guiding principle on administration of medications for child care facilities.

Nancy P. Alexander is Director of Northwestern State University Child and Family Network in Shreveport, Louisiana. She has a bachelor’s degree from Centenary College and a master’s from Northwestern State University. She has completed additional graduate work from Northwestern, Louisiana Tech, and Louisiana State University. Nancy has received several awards, including being selected as one of the One Hundred Women of the Century by the Women’s Business Council of the Shreveport Chamber of Commerce and the Trainer of the Year Award by the North Louisiana chapter of the American Society for Training and Development. She is the author of Early Childhood Workshops that Work: The Essential Guide to Successful Training and Workshops and Nailing Jelly to the Wall: Defining and Providing Technical Assistance in Early Childhood Education, both published by Gryphon House. Nancy is a frequent presenter at regional and national conferences. Her articles and photographs appear in many early childhood professional publications and books. Nancy can be reached at NancyA@nsula.edu

Kim Duncan has been part of the early education community since 1997. She has served children and their families as a classroom teacher, program director, preschool ministry leader and child care administrator. She is currently a Child Care Specialist with Northwestern State University Child and Family Network. Kim has a BS in Family and Consumer Science from NSU, is a CLASS Reliability trainer, a CLASS observer in PreK and Toddler, and a CDA instructor. Kim can be reached at duncank@nsula.edu

Dianna Constant is the Region IV Agenda for Children/Child Care Resources Coordinator. She holds a Bachelor of Arts Sociology and Youth and Family Services. She is also an Office of Public Health, Maternal and Child Welfare Child Care Health Consultant and a consultant with University of Montana Rural Institute on Disabilities – Child Care Plus Team; Consultant with Utah State University Ski - High Institute on Children with Disabilities and a statewide trainer on Inclusive Ideologies. Dianna may be reached by email at dconstant@agendaforchildren.org

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SATURDAY OCTOBER 15, 2016 7:45 – 9:00 AM Continental Breakfast Visit Sponsors

SATURDAY AM SESSIONS All Sessions have been linked to CLASS (Classroom Assessment Scoring System) a tool used to measure teacher effectiveness as

well as TS GOLD (Teaching Strategies GOLD) a child assessment tool used to measure and improve children’s readiness for school!

SESSION G 9 AM – 12 Noon

Cognitive Development &

A Loving Environment

Amanda Rideaux

SESSION H 9 AM – 12 Noon

Supervision should Support School Readiness Goals: The I.N.S.P.I.R.E. Seven Point Plan

Dr. Michael Gaffley

SESSION I 9 AM – 12 Noon

Health and

Safety: Infant and Toddler

CLASS Responsive Caregiving

and/or The Art of Conversation

Dianna Constant

SESSION J 9 AM – 12 Noon

Marvelous

Manipulatives: Tools for Learning (CDA 2)

Nancy P. Alexander

SESSION K 9 AM – 12 Noon

More Than

1, 2, 3: The

Fundamentals of Math for

Preschoolers

Kim Duncan

SESSION L 9 AM – 12 Noon

Are You Making The Most out of

Circle Time?

Juliette Jackson-Semien

SESSION G: Cognitive Development & A Loving Environment with Amanda Rideaux

This course offers a brief description of Piaget’s Theory of Stages of Cognitive Development. Then a detailed account of the 5 Love Languages of

Children will be discussed.

Amanda Rideaux has a Bachelor of Arts degree with a concentration in Public Relations and a minor in Spanish from the University of Louisiana in Lafayette. She has also taken courses at ULL to complete the Alternate Path Certificate in Early Childhood Education. Amanda has completed the Early Childhood Development Diploma Program in 2014. She has over eight years of experience in the child care industry. She is certified CPR/First Aid trained and also completed National Administrator Credential Course for child care center Directors. She recently became a Pathways Approved Trainer for the state of Louisiana as was also issued her Ancillary Teaching Certificate in 2016. Amanda can be reached at amanda_hb@hotmail.com

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SESSION H: Supervision should Support School Readiness Goals: The I.N.S.P.I.R.E. Seven Point Plan

with Dr. Michael Gaffley Supervision is a co-creative partnership based on reciprocal respect for human rights. Effective supervisors know the art and science of working with and through people to produce quality outcomes. Bad attitudes kill noble endeavors. Supervision should support CSSR. If people do not get what they want, they take it anyway.

SESSION I: Health and Safety: Infant and Toddler CLASS Responsive Caregiving and/or The Art of

Conversation with Dianna Constant

Dr. Michael W. G. Gaffley CYC-P is program professor and graduate of Nova Southeastern University and is a certified professional development specialist. He teaches courses in Human Resource Development, Human Resource Management, Leading Change, Diversity and Ethics. He is a Florida DOE certified clinical educator. He is adjunct professor for the John Scott Dailey Florida Institute of Government at FAU. He facilitates capacity building in national programs such as Head Start and Community Action Agencies. He is one of the founding members of the Black Heritage Council and is proficient in the art and science of paradigm shifts, relational education and lifestyle Central Academy in Palatka, FL. He directed intervention work with sexually negotiations in diverse contexts. He is a certified Child and Youth Care Practitioner (CYC-P). He is CLASS reliable. He is a board member of the, physically and emotionally abused children and youth, as well as with foster care and socially excluded families in high risk environments. He is a former executive director of state and human services agencies in South Africa where for more than twenty years he was a driving force in many collaborative community based partnerships. Dr. Gaffley can be reached at dtbc@cultureal.com

Dianna Constant is the Region IV Agenda for Children/Child Care Resources Coordinator. She holds a Bachelor of Arts Sociology and Youth and Family Services. She is also an Office of Public Health, Maternal and Child Welfare Child Care Health Consultant and a consultant with University of Montana Rural Institute on Disabilities – Child Care Plus Team; Consultant with Utah State University Ski - High Institute on Children with Disabilities and a statewide trainer on Inclusive Ideologies. Dianna may be reached by email at dconstant@agendaforchildren.org

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SESSION J: Marvelous Manipulatives: Tools for Learning (CDA 2) with Nancy P. Alexander Learn how your teachers can get the most from the many table toys your center has. Find out how your teachers can use specific manipulatives to meet the Early Learning and Development Standards and how to interact with children to provide instructional support as assessed by CLASS.

SESSION K: More Than 1, 2, 3: The Fundamentals of Math for Preschoolers with Kim Duncan Learn how to create a math-rich classroom that encourages curiosity and a healthy math attitude. By using the Early Learning and Development Standards as a guide teachers can intentionally take advantage of children’s natural curiosity, make the most of their interactions with students, and create great opportunities for assessment

SESSION L: Are You Making The Most out of Circle Time? With Juliette Jackson-Semien Learn what makes circle and group times successful. By using the Early Learning and Development Standards, CLASS, and T.S. Gold as a guide teachers can intentionally take advantage of children’s natural curiosity, make the most of their interactions with students, and create great opportunities for assessment. In this session you will gain tips and ideas for gathering children together and keeping them involved

Juliette Jackson-Semien has been involved in early childhood education for more than 12 years. This experience includes serving children and their families as a classroom teacher, program director, and child care administrator. She is currently a Child Care Specialist with Northwestern State University Child and Family Network. Juliette is a CLASS Reliability trainer, a CLASS observer in the areas of PreK ,Toddler, and Infant. She has a Teaching Strategies Gold Interrater Reliability Certification and is a CDA instructor. Juliette can be reached at semienj@nsula.edu

Nancy P. Alexander is Director of Northwestern State University Child and Family Network in Shreveport, Louisiana. She has a bachelor’s degree from Centenary College and a master’s from Northwestern State University. She has completed additional graduate work from Northwestern, Louisiana Tech, and Louisiana State University. Nancy has received several awards, including being selected as one of the One Hundred Women of the Century by the Women’s Business Council of the Shreveport Chamber of Commerce and the Trainer of the Year Award by the North Louisiana chapter of the American Society for Training and Development. She is the author of Early Childhood Workshops that Work: The Essential Guide to Successful Training and Workshops and Nailing Jelly to the Wall: Defining and Providing Technical Assistance in Early Childhood Education, both published by Gryphon House. Nancy is a frequent presenter at regional and national conferences. Her articles and photographs appear in many early childhood professional publications and books. Nancy can be reached at NancyA@nsula.edu

Kim Duncan has been part of the early education community since 1997. She has served children and their families as a classroom teacher, program director, preschool ministry leader and child care administrator. She is currently a Child Care Specialist with Northwestern State University Child and Family Network. Kim has a BS in Family and Consumer Science from NSU, is a CLASS Reliability trainer, a CLASS observer in PreK and Toddler, and a CDA instructor. Kim can be reached at duncank@nsula.edu

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12:00 NOON - 1:00 PM NETWORKING LUNCHEON AND DOOR PRIZE GIVEAWAYS

SATURDAY AFTERNOON TRAINING SESSIONS All Sessions have been linked to CLASS (Classroom Assessment Scoring System) a tool used to measure teacher effectiveness as well as TS GOLD

(Teaching Strategies GOLD) a child assessment tool used to measure and improve children’s readiness for school! Session M

1:00 – 4:00 PM

Healthy Kids Make Better Learners! Strategies for Active Play and Healthy

Eating in Childcare Centers

Kate Holmes Louisiana Department of Health

Session N 1:00 – 4:00 PM

Exploring our World in the

Outdoor Classroom

Gilen Meibaum-Norwood Martin Luther King Headstart

Session O 1:00 – 4:00 PM

Moral Climate Change is a

Prerequisite for a Constructive

Organizational Climate

Dr. Michael Gaffley

Session P 1:00 – 4:00 PM

Advocacy 101

Cindy Bishop & Earl Willis Checkmate Strategies

SESSION M: Healthy Kids Make Better Learners! Strategies for Active Play and Healthy Eating in Childcare

Centers with Kate Holmes Participants will learn skills and strategies for making their center a healthier place for their staff, teachers and children. From ways to get kids up

and moving to strategies for improving snack and meal times, this training will leave participants energized and armed with the knowledge and

resources to create a healthier center. A center-wide focus on health and wellness gives providers an opportunity to take care of children’s

developing minds and growing bodies in the best way possible. This training will address TS Gold Social-Emotional and Physical objectives and

Emotional and the Classroom Organization CLASS domain.

Kate Garand Holmes is the Early Childhood Education and School Health Leader for the Louisiana Department of Health’s

Office of Public Health. Her work with early care and education sites and schools focuses on increasing physical activity and

improving the nutrition environment with the overall goal of making the places and spaces where we work, live and play

healthier. She received her Masters in Public Health from the University of North Carolina, Chapel Hill and her Bachelors

degree from Millsaps College.

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SESSION N: Exploring our World in the Outdoor Classroom with Gilen Meibaum-Norwood The goal of this presentation is to impress upon participants the value of play in the early childhood classroom whether indoors or in an outdoor environment. How we as an Educator can provide a literacy and numeric environment that promotes learning while at play. In modeling appropriate behaviors in the classroom and community one needs to build security of self which leads to portraying kindness and empathy for those around us. Environment and access to items can make a difference in how a child develops the ability to learn. Play is one of the most important needs that enhances imagination and helps to develop coping skills that become a lifelong. As the Educator how to we accomplish this task or build an environment within our financial means. It is the hope of the Presenter that the participants will understand how to promote and provide for academic exploration as well as discover how important it is in setting up your physical classroom as well as planning your routine to promote innocence while considering what a child needs and see in the environment.

SESSION O: Moral Climate Change is a Prerequisite for a Constructive Organizational Climate with Dr. Michael Gaffley The interpersonal relationships among staff is critical. A strong commitment to ethical practice will enhance outcomes of comprehensive services. Loose thinking leads to sloppy performance.

SESSION P: Advocacy 101 with Cindy Bishop and Earl Michael Willis The Importance of Knowing the Players and the Process! Who are the Players? Overview of the Legislative Process Overview of the Regulatory Process The Importance of Knowing Your “Why” How to Weave Impactful Stories into your Advocacy Message

Gilen Meibaum-Norwood is a single Mother of two boys that enjoys doing for others. Finding ways to open new experiences to others and to the children that are entrusted to me has led me to writing grants and locating inventive ways to meet the needs of my students. To have a full heart one must learn to care for the needs of others. When you help someone of any age discover their strong points and find happiness you discover your self-fulfillment. When you open the doors of wonder and exploration the learning process begins. This begins with self awareness and security. A child needs an opportunity to be a child- innocence is so lost in today’s world as adults we need to be reminded the value of childhood. We all have a little child within us that has needs. Gilen can be reached at StMaryReligion@msn.com

Checkmate Strategies has a long and rich history of advocating on behalf of non-profit organizations. High profile bills such as the School Readiness Tax Credit, Smoke Free Air Act, the Primary Seat Belt Law, the Concealed Carry Bill, are all measures that were by battled by Cindy Bishop and her team. Cindy can be reached at cindy.bishop@checkmate-strategies.com and Earl can be reached at earl.willis@checkmate-strategies.com

Dr. Michael W. G. Gaffley CYC-P is program professor and graduate of Nova Southeastern University and is a certified professional development specialist. He teaches courses in Human Resource Development, Human Resource Management, Leading Change, Diversity and Ethics. He is a Florida DOE certified clinical educator. He is adjunct professor for the John Scott Dailey Florida Institute of Government at FAU. He facilitates capacity building in national programs such as Head Start and Community Action Agencies. He is one of the founding members of the Black Heritage Council and is proficient in the art and science of paradigm shifts, relational education and lifestyle Central Academy in Palatka, FL. He directed intervention work with sexually negotiations in diverse contexts. He is a certified Child and Youth Care Practitioner (CYC-P). He is CLASS reliable. He is a board member of the, physically and emotionally abused children and youth, as well as with foster care and socially excluded families in high risk environments. He is a former executive director of state and human services agencies in South Africa where for more than twenty years he was a driving force in many collaborative community based partnerships. Dr. Gaffley can be reached at dtbc@cultureal.com

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CHILD CARE ASSOCIATION OF LOUISIANA

2016 FALL EDUCATION CONFERENCE

If your childcare center is a CCAL member, all of your employees are entitled to

register. You must be a CCAL Member in order to attend our conference. Check out or

membership application at www.ccalpayment.org

CONFERENCE REGISTRATION FEES

CCAL Members Only

If you are not a CCAL Member, contact Sarah Heath, CCAL Membership Director

at sarah.heath@checkmate-strategies.com or (225) 326-3180

$145 for Friday and Saturday

$85 for Friday only

$75 for Saturday only

AN ADDITIONAL $25 WILL BE ASSESSED PER CENTER

FOR ALL Registrations after October 11, 2016

BOOK YOUR HOTEL ROOM TODAY

Hampton Inn and Suites is our exclusive Hotel for this conference!

Hampton Inn and Suites

2755 Commercial Drive, Port Allen

Located behind the West Baton Rouge Conference Center

(225) 389-6655

$84.00 per night

We have a block of rooms reserved for Thursday October 13, 2016 and

Friday, October 14, 2016

includes a hot breakfast for each occupant

Mention the CCAL Room Block to obtain this special rate

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2016 CCAL FALL EDUCATION CONFERENCE PRE-REGISTRATION

Childcare Center _______________________Name of Person Completing Application: __________________________

Cell Phone # _____________________________ Email Address ____________________________________________

Address _________________________________City State ZIP ____________________________________________

AMOUNT ENCLOSED: $ ____________ Check No.______ Money Order _______ Credit Card ___________

FRIDAY AFTERNOON SESSIONS: A – Cognitive Development & A Loving Environment- Amanda Rideaux (3 hrs.) B – Utilizing Inner Strength to Enhance Leader Effectiveness - Dr. Michael Gaffley (3 hrs.) C – Growing Leaders - Gina Carter (3 hrs.) D – More Than1, 2, 3– Kim Duncan (3 hrs.) E – Marvelous Manipulatives: Tools for Learning (CDA 2) -Nancy P. Alexander (3 hrs) F – Medication Administration - Dianna Constant (3hrs) SATURDAY MORNING SESSIONS: G – Cognitive Development & A Loving Environment - Amanda Rideaux (3hrs) H – Supervision should Support School Readiness Goals – Dr. Michael Gaffley (3hrs) I – Health and Safety: - Dianna Constant (3hrs) J– Marvelous Manipulatives: Tools for Learning (CDA 2)- Nancy P. Alexander (3hrs) K – More Than 1, 2, 3 Kim Duncan (3hrs) L - Are You Making The Most out of Circle Time? Juliette Jackson-Semien (3hrs) SATURDAY AFTERNOON SESSIONS: M – Healthy Kids Make Better Learners! - Kate Holmes (3hrs) N – Outdoor Classrooms - Gilen Meibaum-Norwood (3hrs) O – Moral Climate Change is a Prerequisite for a Constructive Organizational Climate - Dr. Michael Gaffley (3hrs)

P – Advocacy 101 – Cindy Bishop & Earl Willis (3 hrs)

CREDIT CARD PAYMENTS

You may charge your registration by faxing this form to (770) 234-6756 or mailing to: Childcare Association of Louisiana

P.O. Box 80053

Baton Rouge, LA 70898-0053

Childcare Center _______________________________ Cardholder’s Name __________________________

Card No: _____________________________________ Zip Code: _________________________________

Expiration Date: __________________________ Card Security Code: _______________________________

Amount to be charged: ________________________________________

$145 for Friday and Saturday per person

$85 for Friday only per person $75 for Saturday only per person

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All sessions are on a first come, first served basis. Pre-registering for the breakout sessions you’re interested in attending will help us plan

properly to accommodate our attendee’s interests. Thank you!

Please Print the Name of Person(s) You Wish to Register and Mark an X in the Box for the Days they Plan to Attend, please let us know the session they

plan to attend AND indicate whether the person attending has a CDA by putting CDA at the end of their name. Thanks!

Child Care Center Name: _______________________________ Name of Person Completing Application: ______________________________

Name of Registrant

Attending

Friday?

Session

Letter (A-F)

Attending

Saturday?

AM

Session

Letter (G- L)

PM

Session

Letter (M-P)

Registration

Paid

Per Person

$145 for Friday and Saturday per person

$85 for Friday only per person

$75 for Saturday only per person

Total Due: $________

YOU CAN REGISTER ONLINE AT WWW.CCALPAYMENT.ORG