New Class Registration Class: Pro-ACT Training - Live stream (Pacific Time) Training Date: Dec 9, 2024 - Dec 12, 2024 Restraint Training Date: Dec 13, 2024 Class Option --SELECT OPTION-- --- Early Registration Discount Options - MUST BE PAID BY Nov 9, 2024 ---Pro-ACT Training Certification - EARLY DISCOUNT OPTION - 2,230.00Pro-ACT Training + Pro-ACT Restraint Certification - EARLY DISCOUNT OPTION - 2,825.00--- Registration Options - PAID AFTER Nov 9, 2024 ---Pro-ACT Training Certification - 2,330.00Pro-ACT Training + Pro-ACT Restraint Certification - 2,925.00 CEUs Available ProACT: BRN ARF GH RCFE STRTP Restraint: BRN ARF GH RCFE STRTP Fees Due Class Registration Fee$0.00 CEU Options$0.00 Total Due$0.00 Class Registrant Information The "Registrant" information below *MUST* be completed for the student - providing information specific to the person attending the training. The Email address must be unique for the Registrant. (ALL fields are required) Registrant Email: * Confirm Registrant Email: * First Name: * Last Name: * One agency per registration. For additional Sponsoring agencies, call Pro-ACT, Inc at 909-758-0322.For addresses outside the US or Canada, call Pro-ACT, Inc at 909-758-0322. Agency Name: * Position: * Secondary Email: Home Address: * City: * State: *--Select a State--Alberta, CanadaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingIncheon, South KoreaSao Paulo, Brazil Zip: * Day Phone: * Cell Phone: * Documentation Shipping Info ShipTo First Name: * ShipTo Last Name: * ShipTo Street Address: *(No PO Boxes, please) ShipTo Apt/Suite: ShipTo City: * ShipTo State: *--Select a State--Alberta, CanadaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingIncheon, South KoreaSao Paulo, Brazil ShipTo Zip: * This Address is a: * - Residence - Business Location * - required field Sponsor Info MUST READ: Your Sponsor is a person inside your agency/organization who has oversight of your work and the official authorization to execute an Agreement between your organization and Pro-ACT, Inc. Because your Sponsor will receive a copy of the In-service Instructor Agreement via DocuSign, their correct and valid email address must be included. For Instructor-owned entities, provide the same name and email address as for Instructor. Participation in class requires the Agreement be correctly completed by both parties. Sponsor First Name: * Sponsor Last Name: * Sponsor Job Title: * Sponsor Email: * Payment While payment may be made by check, your class registration is not reserved and you will not have access to additional class information until payment in-full is received. Payment by credit card may be made on the following page and confirms your registration immediately. REALLY Important Info: Refunds and Dismissal Policy Review and Acceptance The Pro-ACT, Inc. Refunds and Dismissal Policy may be reviewed by clicking HERE. By checking this box , I certify that I have read and understand the Pro-ACT, Inc. Refunds and Dismissal Policy. Confirmation of Sponsoring Agency Role Participation in a Pro-ACT In-service Instructor training class requires that the individual is either employed as a W-2 employee by or owns and operates an agency in which Pro-ACT training is or will be implemented. The agency then serves as the Sponsoring agency. By checking this box , I confirm that I am employed by the organization identified as my Sponsoring agency. -or- By checking this box , I confirm that I own and operate a business that will serve as my Sponsoring agency. Physical Expectations Understanding Pro-ACT In-service Instructor certification requires participation in physical activities that will include, but not be limited to: stretching; balancing; bending; twisting; moving forward, backward, and side-to-side, and lifting arms. Participation in Pro-ACT Restraint certification training will also require kneeling. By checking this box , I acknowledge that an inability to complete these activities will prevent certification. Submit Registration Press the buttom below to submit the Registration data. You will be directed to the Payment page, where you will complete the payment transaction. You will receive an Email to confirm that we've received your information, along with further instructions.