Preschool Program Update

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Rate Info *This information is not given to parents*

Fill in all that apply:

Monthly

Semester

Preschool

Preschool Program
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:

Please enter total number of vacancies above and indicate details below

Age
3 Years
4 Years
Young 5's

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):

Are you a free preschool/head start?

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

Do you have additional fees for:

Registration
Transportation
Activity Fee

Ages of all children enrolled

Age
Preschool

Is your facility smoke free at all times?

Yes
No

Pet free?

Yes
No

Completely fenced play area?

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

Does staff 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

Does staff 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.

Education requirement for preschool teacher:

Education requirement for aide?

Care setting:

Additional information:

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Footnotes (PDF)
Early On Update (PDF)
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