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Child Care Provider Vacancy Check

Child Care Provider
Email Address (required)

Name as it appears on your license or registration certificate:

Contact name if different:

License/Registration Number: #

Has your address or phone number changed in the past 3 months?

Yes
No

If yes, what is your new address?

Do you have any vacancies as of today? Yes No
IF YES:
Total Number of Vacancies: /LABEL>

Please enter total number of vacancies above and indicate details below

Age	1st Shift	2nd Shift	3rd Shift
0 - 18 Months
19 - 30 Months
31 Months - Preschool
Kindergarten
1^st Grade and Older

If you care for infants and have no infant vacancies at this time:

When do you expect to have an infant opening: MM-DD-YY

Ages of YOUR OWN CHILDREN (in household)
if under 30 months, please list in months

Nearest Elementary School:

School Transportation Provided:

Provider Drives
School Bus (1-2 blocks)
Walking Distance
City bus (1-2 blocks)
None

School Bus Stop Distance (ex: at driveway, 1 block):

Do you accept FIA payments?

Yes
No

If yes, do you require up front payments from parents?

Yes
No

Do you offer backup/drop in childcare (if space is available)?

Yes
No

Days of Operation:

M Tu W
Th F Sat Sun

Hours of Operation:

am - pm

Do you take children:

Part Time (0-30) Hours)
Full Time (30+ Hours)
Both

Are you open:

Full Year
Summer Only
School Year
Major Holidays

Are you willing to work with a rotating schedule?

Yes
No

Rate Info This information is not given to parents Fill in all that apply:
	Hourly		Weekly		Daily
	Part Time	Full Time	Part Time	Full Time	Part Time	Full Time
Infants
Toddlers
Preschool
School Age

Do you have additional fees for:

Registration
Transportation
Diapers/Supplies
Activity Fee

Parents provide their own:

Diapers/Wipes
Formula

Ages of all children enrolled
not including your own

Age
0 - 18 Months
19 - 30 Months
31 Months - Preschool
Kindergarten
1st Grade and Older

Is your home smoke free at all times?

Yes
No

Pet free?

Yes
No

Completely fenced yard?

Yes
No

Air conditioning?

Yes
No

Is there a pool/lake/pond on or adjacent to your property?

Yes
No

Do you offer a sibling discount?

Yes
No

Do you have current:

First Aid
CPR Training

What meals do you serve:

Breakfast
Lunch
Dinner
AM Snack
PM Snack
None (BYO)

Are you participating in a food program?

Yes
No

Would you be willing to work with a special diet?

Yes
No

Do you have any special needs experience such as asthma and breathing treatments, ADD/ADHD, etc.?

Yes
No

Please list below special needs experience or medical training.

Highest level of education completed:

If college courses or degree, please specify:

Care setting:

Additional information:

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Footnotes (PDF)
Early On Update (PDF)
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Child Development Guide
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