CDE Training Request Form
Michael’s Miracles helps children with diabetes have a safe transition into the school setting. This educational service is provided by a Certified Diabetes Educator in conjunction with the child’s parents/guardian. Each training is individualized based on the child’s medical health plan and the specific school requirements and/or limitations. School staff will receive information on basic diabetes education and management skills, depending on the medical plan. However, the necessary skills and daily management will need to be reinforced by the child’s parents/guardian on an on-going basis to ensure competence and compliance with the medical plan.
* Required
Email address
*
Your email
Which training are you interested in?
One on One for a school Nurse
Multiple staff in a school or daycare
Care giver in a home
Full staff training
Other:
Please enter the school or daycare name and address.
*
School or Daycare Name & Address
Your answer
Contact Name & Phone at the school or daycare.
Your answer
Name and age of your child
Your answer
Endocrinologist Information
Name of Doctor and Hospital.
Your answer
How Did you hear about this program?
Your answer
Contact info
Your name
*
Your answer
Phone number
*
Your answer
E-mail
*
Your answer
Preferred contact method
*
Phone
Email
Required
Questions and comments
Your answer
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