4C Education and Training Department
July, August & September 2013 Workshops
4C classes are held at: 6233 Bankers Road, Racine, WI 53403, Ste. 14
Shaken Baby Syndrome - SBS (2 hours)
Fee: $20.00
Shaken Baby Syndrome is a severe form of brain injury that occurs when a child is forcibly shaken. This
workshop includes strategies to aid in the prevention of SBS occurring. Signs for identification and
steps-to-take once identification is made are also reviewed. Note: 4C is an approved agency for this
training. Each of the instructors is also recognized as approved to provide this training. This training is
requires to be completed before beginning interaction with children.
Wednesday, July 24, 2013
10:00 am – 12 noon
Wednesday, August 21, 2013
10:00 am – 12 noon
Wednesday, September 18, 2013
10:00 am – 12 noon
Sudden Infant Death Syndrome – SIDS (2 hours)
Fee: $20.00
This workshop is designed to help child care providers and parents have a better understanding of the
risk factors identified in cases of SIDS deaths and the techniques that have been identified as reducing
the instances of SIDS cases.
Wednesday, July 17 2013
10:00 am – 12 noon
Wednesday, August 14, 2013
10:00 am – 12 noon
Wednesday, September 11, 2013
10:00 am – 12 noon
Please check 4C’s website for all current class offerings: www.4C-forchildren.org
Business Information
Monday thru Friday, 8:30 am – 4:30 pm
Phone: 262-633-0959, Fax: 262-633-5695
Email: racine4C@yahoo.com
4C Continue Education Registration Policies
Please review all policies carefully. Fees will be applied as stated when appropriate.
Class size is limited, please enroll early. You should consider yourself enrolled in the class once the 4C office
has received your registration form and fee.

You are responsible for remembering the time, date and place of the class you registered for.

Due to the short timeframe of workshops, participants will not be allowed to stay if they are more than
15 minutes late. There will be no refund due to lateness.

Any student who attends class and is not pre-registered will incur a late registration fee of $10.00 for any
class or workshop.
THERE ARE NO EXCEPTIONS!

Any student who register’s 1 business day prior to the start date of class; will receive their certificate via
mail within 7-10 business days after class.

No Refunds or Transfers or Substitution granted for workshops.

Any name spelling or address corrections must be done within 2 working days of the workshop.

4C reserves the right to change the location of a class at any time if it becomes necessary. Registered
students will be notified of the change.

No Guns Allowed on 4C Property.

4C reserves the right to cancel a workshop due to low enrollment. In that case, registered students will be
notified and other arrangements will be made. This will be done within 2 business days before the start of
the workshop.
PAYMEMNTS

Submit the completed registration form with payment to 4C. This can be done: in the office via cash,
check, money order, VISA, Discover or MasterCard.

Register through the mail with check or money order; or through our website: www.4c-forchildren.org.

Over-the-phone with VISA or MasterCard You will need to fax your completed registration to 4C. Upon
receiving your fax, 4C will contact you to obtain your credit card information for payment.

There is a $35.00 fee for all returned checks. (Students with outstanding balances will not receive
certificates until balance is cleared.)

Emergency cancellations (i.e. weather) will be broadcast on WTMJ Channel 4 or Radio AM 620
Revised 6/13
4C for Children Registration Form
Please PRINT Clearly and give current information. This information is what is used for your certificate
and if a class has been changed or cancelled. Use one form per person.
Last Name:
First Name:
Address:
City, State, Zip:
Home Phone:
Work/Cell Phone:
E-Mail Address:
Registry #: _________________
Birth date: ___ ___ / ___ ___ / ___ ___ ___ ___
Last 5 digits of Social Security (for database use): 000 - 0
-
.
Class
Selection
Please check  next to the class you are 
registering for. Write the Start Date on the line.
 

Class



Start Date
Fee
Shaken Baby Syndrome – SBS
$20.00
Sudden Infant Death Syndrome - SIDS
$20.00
Suspected Child Abuse & Neglect -SCAN
Number of Classes Registered for:
Total Fee:
NOTE: No refunds or transfers for the classes listed above. 4C accepts Credit or
Debit Cards, Money Order, Cash – exact dollar amount please.
Make Money Order Payable and Mail to:
Initial here to indicate that you have
read or heard the 4C Registration information.
Payment Date:
CA/CR/MO#
Internet/In-Person/Mail/Phone
Process Date:
4C for Children
6233 Bankers Rd, Ste. #14
Racine, WI. 53403
Office Use Only 2013
Paid by:
Total Amount:
4C Rep:
BI / BNI
SBS
SIDS
SCAN