Request edit access
On-Site Professional Development TRAINING WORKSHOPS - Booking Request Form
*Prices vary depending on length and number of attendees. Please fill out this scheduling form completely.

Kristin Miller, M. Ed. is the registered TX trainer (#10550), certified child care health consultant, professional educator, and lead presenter. She will be in touch with you to discuss further details and confirm your training workshop reservation.

PLEASE NOTE: If you are wanting to reserve more than one training workshop session (multiple topics) - Ms. Miller will be happy to present more than one training workshop session at a time for your facility and staff. Full day PD workshops can be reserved for your program, with multiple training topic sessions provided. She will work with you to plan, schedule, and organize a full PD training day for your programs needs.
Email address *
Director/Principal First & Last Name *
Please list the person responsible for scheduling this training and the best point of contact who leads your program.
Your answer
What kind of facility do you lead, own, or operate? *
Name of Facility *
What is the name of your educational program, public or private school, child care center, or in-home daycare?
Your answer
Choose Your TRAINING WORKSHOP TOPIC! *
Please select which training workshop topic you would like to schedule for your staff, team, self, or employees! NOTE: IF YOU WANT MULTIPLE SESSION TOPICS for your teaching staff team, please click "OTHER" and write in the titles of choice.
How many employees, or attendees, do you expect to attend this training workshop? *
Please list a number to the closest maximum amount, including yourself, if you plan to attend.
Your answer
Please select the preferred DATE you would like the professional development training to be on *
Please note: Due to scheduling conflicts and high demand, some dates may already be full. I will try to accommodate your day/time request, and be flexible to work with you as much as possible to meet your needs.
MM
/
DD
/
YYYY
Please select the preferred TIME you would like the professional development training to be at *
Please note: Due to scheduling conflicts and high demand, some time options may already be taken. I will try to accommodate your time request, and be flexible to work with you as much as possible to meet your needs.
Time
:
Phone Number 1 *
Your answer
Location Address *
Your answer
What is the age range of children your program provides services for? *
Please list the age ranges of children in whom your staff teaches.
Your answer
Tell me How.... *
Please select how you heard or found out about my unique training workshops, below!
Payment Policy Consent *
For all training workshops PAYMENT IS DUE IN FULL BEFORE, or on the SAME DAY, as TRAINING'S ARE RENDERED, either by a credit/debit card payment, or personal check. All fees are non-refundable.
Signature of authorized representative *
By signing below, you are agreeing to schedule this training workshop for your school, self, or program. You have read and fully understand all details, workshop descriptions, and policies as stated above. This signature verifies understanding and acceptance of this registration.
Your answer
Signed this day
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service