CalSAC's 10th Annual CA Afterschool Challenge Registration
May 12-13, 2014

CalSAC's 10th Annual CA Afterschool Challenge
May 12 - 13, 2014 ~ Sacramento, CA

The CA Afterschool Challenge aims to educate and inspire professionals, youth, and parents in afterschool and school-age care programs to engage in grassroots advocacy to advance the out-of-school time field.

This unique event, held each May, includes a full day of training and networking that culminates with legislative visits and a rally at the State Capitol. Training is provided for middle and high school youth, professionals and experienced advocates. Participants learn about the issues impacting the out-of-school time field as well as educate legislators about the importance of these vital afterschool and school-age care programs from their first hand experience.

Please complete one registration form per adult attendee. Registration is FREE.

Visit the CA Afterschool Challenge webpage for more event details - https://calsac.org/get_involved/advocacy.

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1. First Name: (Required.)

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2. Last Name: (Required.)

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3. Organization Name: (Required.)

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4. Title at Organization: (Required.)

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5. Home Phone Number: (xxx-xxx-xxxx)

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6. Work Phone Number: (Required.)

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7. Cell Phone Number: (Required.)

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8. Email Address: (Required.)

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9. Home Address: (Required.)

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10. City: (Required.)

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11. State:

Other

If other (please specify)

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12. Zip Code: (Required.)

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13. Work Address: (Required.)

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14. City: (Required.)

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15. State:

Other

If other (please specify)

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16. Have you attended the CA Afterschool Challenge in the past? (Required.)

Yes

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17. Which of the following would you consider yourself to be? (Required.)

I currently or have in the past worked in the policy field

I am an experienced advocate (knowledgeable and comfortable with the legislative process, OST policy and visits with legislators)

I am an emerging advocate (limited to no experience with the legislative process\, OST policy and legislative visits)

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18. What days will you be attending? (Required.)

Monday and Tuesday (May 12 & 13)

Monday only (May 12)

Tuesday only (May 13)

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19. Program Type (check all that apply): (Required.)

School-based Afterschool (Public and/or Private funding)

School-based Child/School-Age Care (Public and/or Private funding)

Community Based Organization

Licensed Family Child Care

Boys and Girls Club

Park and Rec

YMCA

Girl's Inc.

4-H Council

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20. Population Served (check all that apply): (Required.)

K - 2nd Grade

3rd - 5th Grade

6th - 8th Grade/Middle School

9th - 12th Grade/High School

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21. Do you require a vegetarian meal? (Required.)

Yes

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22. Would you like to be a legislative visit Team Leader? (Required.)

Yes

Maybe - send me more information

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23. Are you registering youth? (Required.)

Yes

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* 1. First Name: (Required.)

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* 2. Last Name: (Required.)

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* 3. Organization Name: (Required.)

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* 4. Title at Organization: (Required.)

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* 5. Home Phone Number: (xxx-xxx-xxxx)

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* 6. Work Phone Number: (Required.)

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* 7. Cell Phone Number: (Required.)

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* 8. Email Address: (Required.)

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* 9. Home Address: (Required.)

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* 10. City: (Required.)

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* 11. State:

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* 12. Zip Code: (Required.)

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* 13. Work Address: (Required.)

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* 14. City: (Required.)

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* 15. State:

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* 16. Have you attended the CA Afterschool Challenge in the past? (Required.)

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* 17. Which of the following would you consider yourself to be? (Required.)

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* 18. What days will you be attending? (Required.)

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* 19. Program Type (check all that apply): (Required.)

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* 20. Population Served (check all that apply): (Required.)

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* 21. Do you require a vegetarian meal? (Required.)

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* 22. Would you like to be a legislative visit Team Leader? (Required.)

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* 23. Are you registering youth? (Required.)

1. First Name: (Required.)

2. Last Name: (Required.)

3. Organization Name: (Required.)

4. Title at Organization: (Required.)

5. Home Phone Number: (xxx-xxx-xxxx)

6. Work Phone Number: (Required.)

7. Cell Phone Number: (Required.)

8. Email Address: (Required.)

9. Home Address: (Required.)

10. City: (Required.)

11. State:

12. Zip Code: (Required.)

13. Work Address: (Required.)

14. City: (Required.)

15. State:

16. Have you attended the CA Afterschool Challenge in the past? (Required.)

17. Which of the following would you consider yourself to be? (Required.)

18. What days will you be attending? (Required.)

19. Program Type (check all that apply): (Required.)

20. Population Served (check all that apply): (Required.)

21. Do you require a vegetarian meal? (Required.)

22. Would you like to be a legislative visit Team Leader? (Required.)

23. Are you registering youth? (Required.)