AGE RANGE	Desired Capacity	Licensed Capacity	Full-Time Vacancy	Part-Time Vacancy
Infant 1 Group (0-6 Months)
Infant 2 Group (6-12 Months)
Toddler 1 Group (1-2 Years)
Toddler 2 Group (2-3 Years)
Preschool 1 Group (3-4 Years)
Preschool 2 Group (4-5 Years)
School Age 1 Group (6-8 Years)
School Age 2 Group (9+ Years)

 

FINANCIAL ASSISTANCE

Family Discount Offered        Financial Assistance Accepted
 

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POLICIES

Written Contract     Written Handbook     Multi-Child Discount     Provider Sick Allowance     Provider Vacation Allowance

Child Absence Allowance     May Give Rates     Maintain Liability Insurance
 

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SPECIAL SKILLS

Administrator's Credential     School Age Credential     Infant/Toddler Credential     CDA     RN/LPN/CNA

 

SPECIAL NEEDS

Emotional/Behavioral Disability Training     Emotional/Behavioral Disability Experience     Physical Disability Training    

Physical Disability Experience     Cognitive Disability Training     Cognitive Disability Experience    

Sensory Disability Training     Sensory Disability Experience     Health/Medical Disability Training    

Health/Medical Disability Experience     Feeding Tube Training     Feeding Tube Experience     Monitor Training    

Monitor Experience     Provide Special Diet     Administer Shots     No Training/Experience

 

TRAINING

Infant/Child CPR     First Aid     SIDS: Sudden Infant Death Syndrome

 

EDUCATION

Required Licensing Course     Required Certification Course     Required Infant/Toddler Course    

Required Lead/Assistant Teacher Course     1 Year Diploma - Child Related     2 Year Degree - Child Related

2 Year Degree - Non Child Related     4 Year Degree - Child Related     4 Year/Master's Degree - Non Child Related

Master's Degree - Child Related

 

ACCREDITATION

NAFCC     NSACA     NAEYC

 

AFFILIATION

Employer Sponsored (for profit)     Employer Sponsored (not for profit)     Government Sponsored     For Profit

Not for Profit     Self-Employed
 

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GROUP CENTER SETTING

Faith-Based     Non-Residential     Workplace-Based

Census Bureau Questions (Optional - for statistical purposes only)
 

Number of persons on staff who are Spanish/Hispanic/Latino:

Mexican     Mexican American, Chicano     Cuban     Other Spanish/Hispanic/Latino  (enter group)

Number of persons on staff who's race is:

White     Black     American Indian or Alaska Native     Asian Indian     Native Hawaiian     Chinese     Filipino

Japanese     Vietnamese     Other Race (enter race)
 

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FAMILY HOMES

House     Mobile Home     Apartment     Duplex     Townhouse     Non-Residential

 

Census Bureau Questions (Optional - for statistical purposes only)
 

Number of persons on staff who are Spanish/Hispanic/Latino:

Mexican     Mexican American, Chicano     Cuban     Other Spanish/Hispanic/Latino  (enter group)

Number of persons on staff who's race is:

White     Black     American Indian or Alaska Native     Asian Indian     Native Hawaiian     Chinese     Filipino

Japanese     Vietnamese     Other Race (enter race)

 

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YOUR PRIVACY RIGHTS

Our mission is to provide parents with objective information about child care programs in their community and information on selecting quality child care. CCR&R does not endorse or recommend any particular child care program. Parents are strongly encouraged to visit each site and ask questions about policies and procedures of the program before making a final decision. We will not guarantee that you will receive prospective parents from CCR&R. We encourage you to continue to advertise through local newspapers, church, and other organizations. We ask that you notify CCR&R of any vacancies or changes in your program (hours of operation, phone number, address, etc.)

The purpose of collecting the information in this form is to:

1. Effectively provide referrals to parents who are looking for child care and provide appropriate program information.

2. Report and gather statistics on child care needs.

3. Provide training and technical assistance to meet your needs as a child care provider.

You are not required to provide this information, but without it, we will not be able to help parents locate your program. In addition, the information is used for statistical reporting that influences planning, policy development, and funding levels. Statistical information never includes provider names and may be shared with community groups, etc. At times, we receive requests for a mailing list of providers from outside sources that have a legitimate provider interest, such as a public health alert, etc. This information (name, address) is public information. Other information about your program is not provided to outside vendors.

This notice covers all changes you make in your file (by phone, in person, or written) until your file is deleted from the database.

I authorize the information in this form to be used as outlined above.

Yes. (By clicking in this box you are electronically signing this agreement.