Thank you for registering for professional development with One Place. Please direct all training questions and concerns to Shannon Niro, Early Education Administrative Coordinator at shannon.niro@oneplaceonslow.org

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* 1. Name

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* 2. Email Address- this email address is where you will receive your link to access training and your training certificate.

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* 3. Sign me up to receive email updates about One Place!!

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* 4. Primary Telephone Number

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* 5. Age

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* 6. Gender

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* 7. Race/Ethnicity

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* 8. Are you military affiliated? (Active Duty, Veteran, or Dependent)

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* 9. Employer/Child Care Facility Name (Choose N/A and type your center name in OTHER box if your center is not listed)

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* 10. Child Care Facility Type

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* 11. County of Employment (Please choose OTHER and type your county of employment if your county is not listed)

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* 12. Early Educator Job Status

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* 13. Age Group of Children you Serve
(check all that apply)

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* 14. Number of Children you Served by Age Group (all sections must be filled- type a zero in the sections that do not pertain to you):

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* 15. I wish to register and submit payment for Stay Healthy, Stay Clean Part 1 & 2(In Person)-on July 31, 2025 and August 5, 2025-6:30 PM to 8:30 PM

You’ll enter payment info after the survey.

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* 16. Special Instructions (Any allergies, hearing/sight barriers, language barriers, etc that the instructor should be aware of. All information will be kept confidential)

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