Registration Form
E-mailed* Mailed
Adult Learning Styles __$75.00 __$95.00
10 Clock Hours (EDU)
Memory Care -Program Development _$75.00 __$95.00
10 Clock Hours (MC)
Internet Resources & Adult Day
Care
10 Clock Hours (AD) _$75.00 _$95.00
Your Community & Adult Day
Care
10 Clock Hours (AD) __$75.00 __$95.00
Individualized Activities & Adult Day
Care
10 Clock Hours (AD) __$75.00 __$95.00
Activities Documentation Course
7 Clock Hours _ $75.00 _ $89.00
Activities to GO!
8 Clock Hours _ $75.00 _ $89.00
Person Centered Activities (1-1’s)
30 Clock Hours _$150.00 _ $175.00
Volunteer Management
The Activities/Volunteer Director
30 Clock Hours (ADC)
40 Clock Hours (ACC) _ $150.00 _$175.00
Community Resources - Home Town
Challenge
15 Clock Hours __ $75.00 __$95.00
Computer Skills - Internet Resources __ $75.00 __$95.00
15 Clock Hours
Activities Inservices and Handouts
An "E-Book" _ FREE _ $5.99
Total Due: _________ _________
*Please note: To receive your course via an e-mail attachment, you must have the Microsoft Word program and a complete e-mail address that will accept attachments from Activities Assistance.
Name___________________________________________________
Address_________________________________________________
________________________________________________________
E-Mail Address: ____________________________________________
Copy this registration form and check the courses that you would like
Mail Check and Registration form to:Activities Assistance
201 Kittell Rd.
Fayetteville, NY 13066
Phone: 315-446-4607
Email:
kathy@activitiesassist.com
Please note: We are unable to take credit cards. Please copy off this form, fill it in and send a check or money order to Activities Assistance