Online Profile Form






Provider Profile

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Contact Information
As appears on license
First Name of Owner or Director
Last name of business owner or director
Location Address
Example: Harry & Oliver
Mailing Address
County you would like your report to cover?

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*
*

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Please provide your email address
License Information

School Information
School transportation

Add another elementary school

We can list three shift options in our database.  Complete the shift option section for each shift you offer (up to three).  After completing the first shift you provide, click the add another shift option button to add another one.

Shift Option








Start Time End Time
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Rates & Capacity
Part Time Rate Rate Type Desired Capacity Licensed Capacity Desired SRS Capacity # Children Per Adult Number in Total Group
Under Age 1
1 up to 1.5
1.5 up to 2
Age 2
Age 3
Age 4
Age 5
6 & Over
Vacancy Information

TIP: Remember to keep your vacancies updated!  You can always call or visit the website to update your vacancies!

Full Time Vacancies Part Time Vacancies Vacancy Date
Under Age 1
1 up to 1.5
1.5 up to 2
Age 2
Age 3
Age 4
Age 5
Age 6 & Over

Add another shift (up to 3)

Environment
















Meals








Philosophy









Policies








Training, Education, Experience & Skills




























Family Child Care Owners











Census Questions
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Need assistance with this form?

You may also choose to contact Candace Malone to update your information or print off a pdf version of this form (Family Child Care Profile) or (Child Care Center Profile) and mail in.

 

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