Individual Registration Form: Learning Management System (LMS) Powered by Child360
Please complete this form to register for the LMS system provided by Child360. If your agency is paying for the courses, you must still complete this form in its entirety. You or your agency will receive an invoice (if applicable) from OCAEYC and registration instructions from Child360. Payment must be received and processed prior to access to course(s). Please allow two weeks to process.
Name: *
Email Address *
Phone Number *
Employer/Agency Name *
Type of Registration *
Today's Date: *
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OCAEYC Member *
OCAEYC Membership Number (if unsure, mark n/a) *
Membership Expiration Date (if unsure, leave blank)
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Membership Level *
How many courses do you want access to? *
Please choose which courses you would like to enroll in (# of choices must match the # of courses you are eligible for based on your choice above): *
Required
How will you be paying? Please type in the method of payment: Credit Card, Check, Free Courses, or Employer (enter Employer Email below) *
Required
* Agency/Employer Contact Information (Please list Supervisor's name, email, and phone # below)
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