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New Service Provider Registration

How did you learn about this site? *

	Seminar
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Credentials

Please enter your information below

Do you have a license?

Yes No

If yes, please enter

License#

(type "same" if same as your ss#)

Please do NOT include
Social Security Number

State(s) Licensed

Do you have a certificate?

Yes No

If yes, please enter

State Certification Issued

Area of Certification

If no, please enter

Highest Degree

School Attended

Check Who You Want to be Contacted By *

Parents

Agencies/Schools

Both

Attach Your Resume & Copy of License/ Certificate*

If you cannot upload, please fax documents to: 516-616-5190.

Select Type of Discipline *

Use the 'ctrl' button to
select multiple disciplines

If Other

Specialization

Availability

	Mornings		Afternoons		Evenings
	After 7 pm		Saturday		Sunday

Which Geographic Areas are you interested in servicing? Please enter all areas you are interested in servicing and separate each by a comma (ex: New York, Garden City, Floral Park, etc.)

Terms & Conditions*

To Please review the information you've entered above and review and accept our Terms of Conditions below to continue

MY EARLY SUCCESS, INC. Terms and Conditions 

My Early Success, Inc. is dedicated to providing families, agencies, schools, and districts with resources to support them as they serve our communities.  We provide links and/or information to independent service providers focused on the special needs of our families, these service providers are not employed by nor affiliated with My Early Success, Inc.  My Early Success, Inc. is not making recommendations to these services providers, we are simply making their information readily available for your review.  Although we do a preliminary screening, it is always recommended that credentials be checked by users.

PLEASE READ THE FOLLOWING TERMS AND CONDITIONS RELATING TO YOUR USE OF THIS SITE CAREFULLY. By using this site, you are deemed to have agreed to these terms and conditions of use. We reserve the right to modify them at any time. You should check these terms and conditions periodically for changes. By using this site after we post any changes to these terms and conditions, you agree to accept those changes, whether or not you have reviewed them.  If at any time you choose not to accept these terms and conditions of use, please do not use this site. 

Scope of Terms and Conditions 
These terms and conditions apply to your use of the sites and services owned or operated by My Early Success, Inc., and any other site that we have owned or operated, do own and operate or may own or operate in the future. Unless we say otherwise, all references to the Sites in these terms and conditions include all such sites. These terms and conditions do not apply to your use of unaffiliated or third party sites to which My Early Success, Inc. only links. 

Restrictions on Use of Materials 
The contents of our sites are protected by copyright and trademark laws, and are the property of their owners.  Unless we say otherwise, you may access the materials located within My Early Success, Inc. only for your personal use. This means you may download one copy of posted materials on a single computer for personal, noncommercial home use only, so long as you neither change nor delete any author attribution, trademark, legend or copyright notice. When you download copyrighted material you do not obtain any ownership rights in that material.  You may not modify, copy, publish, display, transmit, adapt or in any way exploit the content of My Early Success, Inc.  Only if you obtain prior written consent from us, and from all other entities with an interest in the relevant intellectual property, may you publish, display or commercially exploit any material from My Early Success, Inc. 

You must abide by all additional copyright notices or other restrictions contained in any of the My Early Success, Inc. Links.

These terms and conditions apply only to My Early Success, Inc., and not to the sites of any other companies or organizations, including those to which families, service providers, agencies, schools, districts may link.  We are not responsible for the availability of any other site to which our Sites link. We do not endorse or take responsibility for the contents, advertising, products or other materials made available through any other site.  Under no circumstances will we be held responsible or liable, directly or indirectly, for any loss or damage that is caused or alleged to have been caused to you in connection with your use of, or reliance on, any content, goods or services available on any other site. You should direct any concerns to that site's administrator or webmaster. 

Other sites may link to My Early Success, Inc. only through a plain-text link. Permission must be granted by us for any other type of link. To seek permission, you may write to My Early Success, Inc. 225 Beech Street, Floral Park, NY  11001. We reserve the right, however, to rescind any permission granted by us to link through a plain-text link or any other type of link, and to require termination of any such link to My Early Success, Inc., at our discretion at any time. 

Submissions 

We welcome your comments about My Early Success, Inc. However, unless our site has set up a specific submissions policy, we will not review or consider any unsolicited creative submissions. We must ask that you not send us any original creative ideas, suggestions or materials. If you send us a submission or creative idea, we will not be obligated to keep it confidential and we will not be liable for any use or disclosure of any submission. If you are submitting something to a site that has set up a submissions policy, please consult that site for its specific requirements. 

Disclaimers 
THE SERVICES, PRODUCTS AND MATERIALS ON THIS SITE ARE PROVIDED "AS IS" AND WITHOUT WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED. WE DISCLAIM ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE. 
NEITHER WE NOR ANY OF OUR RESPECTIVE LICENSORS OR SUPPLIERS WARRANT THAT ANY FUNCTIONS CONTAINED IN THE SITES WILL BE UNINTERRUPTED OR ERROR-FREE, THAT DEFECTS WILL BE CORRECTED, OR THAT THE SITES OR THE SERVER THAT MAKES THEM AVAILABLE ARE FREE OF VIRUSES OR OTHER HARMFUL COMPONENTS. 
NEITHER WE NOR ANY OF OUR RESPECTIVE LICENSORS OR SUPPLIERS WARRANT OR MAKE ANY REPRESENTATIONS REGARDING THE USE OR THE RESULTS OF THE USE OF THE SERVICES, PRODUCTS OR MATERIALS IN THIS SITE IN TERMS OF THEIR CORRECTNESS, ACCURACY, RELIABILITY, OR OTHERWISE. YOU (AND NOT WE OR ANY OF OUR RESPECTIVE LICENSORS OR SUPPLIERS) ASSUME THE ENTIRE COST OF ALL NECESSARY SERVICING, REPAIR OR CORRECTION TO YOUR SYSTEM.  APPLICABLE LAW MAY NOT ALLOW THE EXCLUSION OF IMPLIED WARRANTIES, SO THE ABOVE EXCLUSION MAY NOT APPLY TO YOU. 
We do not endorse, warrant or guarantee any products or services offered on the Sites. We are not a party to, and do not monitor, any transaction between users and third party providers of products or services. 

Limitation of Liability 
UNDER NO CIRCUMSTANCES, INCLUDING BUT NOT LIMITED TO NEGLIGENCE, WILL WE OR ANY OF OUR LICENSORS OR SUPPLIERS BE LIABLE FOR ANY SPECIAL OR CONSEQUENTIAL DAMAGES THAT RESULT FROM THE USE OF, OR THE INABILITY TO USE, THE MATERIALS ON THE SITES, OR ANY PRODUCTS OR SERVICES PROVIDED PURSUANT TO THE SITES, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. APPLICABLE LAW MAY NOT ALLOW THE LIMITATION OR EXCLUSION OF LIABILITY OR INCIDENTAL OR CONSEQUENTIAL DAMAGES (INCLUDING BUT NOT LIMITED TO LOST DATA), SO THE ABOVE LIMITATION OR EXCLUSION MAY NOT APPLY TO YOU. IN NO EVENT SHALL THE TOTAL LIABILITY TO YOU BY US OR ANY OF OUR LICENSORS OR SUPPLIERS FOR ALL DAMAGES, LOSSES, AND CAUSES OF ACTION (WHETHER IN CONTRACT, TORT, OR OTHERWISE) EXCEED THE AMOUNT PAID BY YOU TO US, IF ANY, FOR ACCESSING FAMILIES INC. 
No Personal Advice 

The information contained in or made available through My Early Success, Inc. (including but not limited to information contained on message boards, in text files, or in chats) cannot replace or substitute for the services of trained professionals in any field, including, but not limited to, financial, medical, or legal matters.  In particular, you should regularly consult a doctor in all matters relating to physical or mental health, particularly concerning any symptoms that may require diagnosis or medical attention. We and our licensors or suppliers make no representations or warranties concerning any treatment, action, or application of medication or preparation by any person following the information offered or provided within or through the Sites. Neither we nor our partners, or any of their affiliates, will be liable for any direct, indirect, consequential, special, exemplary or other damages that may result, including but not limited to economic loss, injury, illness or death. 

Privacy Policy 
We are committed to protecting your privacy and security and have explained in detail the steps we take to do so. We urge you to read our Privacy Policy. 

Jurisdictional Issues 
We control and operate this site from our offices in the United States of America. We do not represent that materials on the site are appropriate or available for use in other locations. Persons who choose to access this site from other locations do so on their own initiative, and are responsible for compliance with local laws, if and to the extent local laws are applicable. 

Your Acceptance of These Terms 
By using My Early Success, Inc., you signify your acceptance of our Terms and Conditions of Use. If you do not agree to this policy, please do not use our sites. Your continued use of My Early Success, Inc. following the posting of changes to these terms will mean that you accept those changes.

Accept Terms & Conditions*

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