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Summer Care 
Program Update Form

Child Care Resources, Southwest Michigan 4C provides parents in southwestern Michigan with information describing various options for summer care. If you would like your program information provided, please fill out the form below. (Submit each program separately.)

If you have any questions, please call Cindy at Child Care Resources,  800-343-3470, ext. 244.
Please "Tab" though this update. (Pressing "Enter" will submit form!)
Today's Date:
Camp/Program Name:
Contact Name & Title:

If your program is a Licensed Child Care facility,  please provide your license number:
Year Round Phone Number: 
Agency Name:
Agency Mailing Address:
Location of Program (if not mailing address):

Ages Served:

 Youngest to Oldest
Date of Summer Program: Start Date to End Date
Daily Hours of Operation:
Open Earliest Open Latest
Full Time Part Time Days Only
Other:
Transportation provided?
Yes No
Fee information:
Regular Tuition Free Program  Scholarships Available Sibling Discount
Can you accommodate children with varying levels of abilities?
Yes No  If "Yes" please check all that apply:
ADD/ADHD Asthma/Breathing Cerebral Palsy
Hearing Impaired Visually Impaired Seizure Disorder
Autism Down Syndrome Bipolar
Sensory Integration
Building is Physical Handicap Accessible
Other, please list
Are any languages other than English spoken and understood? List:
Does this program hold any Accreditation?  List type:
Program Description (i.e., services you offer, curriculum type, child/staff ratio, staff training/education, etc.):
Comments: