2025 Membership Form

2025 Membership Application

Family Child Care & Group Homes
Note: If you are adding staff, complete the staff profile page below. NO REFUNDS! ALL PAYMENTS ARE FINAL.
Name*

First NameLast Name
Gateways Number*
Childcare Program Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone
Please enter a valid phone number.
Cell Phone*
Please enter a valid phone number.
Email*
example@example.com
Current Educational Level*

High School Diploma/GEDAssociate DegreeBachelor's DegreeMaster Degree
Are you working toward a credential advancement or an Early Childhood Education Degree? If so, please check which one(s)*

ECE Level OneCDA ( Child Development Associate)C2K (Childhood to Kindergarten)Director's CredentialECE Level 2-5NAFCC (National Association for Family Childcare
Would you like to receive text message reminders for meetings & events?*

YesNo

Membership*

Family ChildcareMembership includes 1 additional staff person or assistant.

$150.00

Group HomeMembership includes 2 additional staff or assistants.

$200.00

Total

$0.00

Staff Person 1
Cohort Requirements:
- 480 hours (6 months) of working in a childcare setting
- High School diploma/GED or currently enrolled/attending high school
Staff #1: What Cohorts are your staff interested in?:

CDA (Child Development Association)NAFCC (National Association for Family Child Care)C2K (Childhood to Kindergarten)
Staff Person 2
Cohort Requirements:
- 480 hours (6 months) of working in a childcare setting
- High School diploma/GED or currently enrolled/attending high school
Staff #2: What Cohorts are your staff interested in:

CDA (Child Development Association)NAFCC (National Association for Family Child Care)C2K (Childhood to Kindergarten)
Statement of Agreement: I agree to fulfill all requirements set forth in the bylaws of ACPN. I promise to take my membership seriously and to commit to act responsibly to my ACPN obligations.

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2025 Membership Application