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Program Update

Happy New Year! If you have filled out this form SINCE October 1, 2007 and have no major changes: 
 Check out the "QUICK UPDATE!" 

Confidentiality - Provider information collected by Child Care Resources staff related to the referral database will be kept for staff and/or parent utilization only. CCR does not sell or share child care provider/program or parent names, addresses, phone numbers, or any other personal information to any outside agencies for solicitation purposes.
General Program Information For licensed/regulated child care HOMES in the counties of  Barry, Branch, Berrien, Calhoun, Cass, Kalamazoo, St. Joseph and Van Buren.

Please "Tab" though this update. (Pressing "Enter" will submit form!)
Today's Date:
Provider Name:
Phone Number (area code):
Business Name:
E-Mail Address:
Web Site
Address, City, Zip:

What two "major" streets intersect (cross each other) nearest your home?
Are you a member of a Child Care Food Program?
Yes Food Program No Food Program
If "NO" do you provide meals? Yes Meals No Meals
Yes Snacks No Snacks
Would you accommodate a child with a special diet?  Yes No
Is your yard fenced in?
Yes Fence No Fence
Do you have a pool or are you on a lake/pond?
Yes Pool/Lake/Pond No Pool/Lake/Pond
Do you have pets at your house? 
Yes Pets No Pets
Does anyone ever SMOKE in the house (after child care hours)?
Yes Smoking in House No Smoking Ever in House
Will you provide TRANSPORTATION to and/or from School/Preschool on a regular basis? Yes Transportation No Transportation
Program Environment Please mark all that apply to your program environment. 
Hold down the "Ctrl" button and click:

Do you offer a curriculum in your program?
Yes Curriculum No Curriculum
Do you use a written  contract/handbook and keep necessary financial records? Yes Contract/Handbook & Records No Contract/Handbook & Records
Program Hours and Vacancy Information
Days you will provide care. Check all that apply:
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Hours you will provide care.
Very Earliest Very Latest Provide 24 Hour Care
Do you prefer providing care:

Do you provide care Year round or School year only?
Do you now or will you consider providing Before and After School care? Yes Before School No Before School
Yes After  School No After School
  • Would you accommodate a full time family with a rotating schedule? 
Yes Rotating schedule No Rotating schedule
  • Would you take a child on a "drop in" basis? (Pre-planned, but inconsistent schedule of care.)
Yes Drop In No Drop In
  • Would you accept a child for Emergency care? (Quick hire, long and short term care)
Yes Emergency Care No Emergency Care
  • Respite care: Will you take children with special needs who need short term care?
Yes Respite Care No Respite Care
  • Migrant care: Will you take children on a temporary/seasonal basis?
Yes Migrant Care No Migrant Care
Yes Holiday Care No Holiday Care
What is the youngest and oldest ages you will ever consider for your program?   Youngest to Oldest
Vacancy check:
How many INFANT vacancies? FT     PT
How many TODDLER vacancies? FT     PT
How many PRESCHOOL vacancies? FT     PT
How many SCHOOL AGE vacancies? FT     PT

Total number of openings (all ages):
Do have 2nd or 3rd shift vacancies?
Do NOT Provide 2nd or 3rd shift care  No 2nd or 3rd shift Vacancies
# of Vacancies 2nd Shift Age Range 2nd Shift
# of Vacancies 3rd Shift Age Range 3rd Shift
Child Care License Information 
License #
Expiration Date
Date Issued
Infant/Child CPR Expiration Date
First Aid Certification Expiration Date
Program, Training and  Experience  Information
Will you consider accepting partial payment for child care directly from the Department of Human Services (DHS)?
Yes No
Do you require a deposit upon enrollment?
Yes No
Do you charge less than full price for the second child from the same family?
Yes No
Is your program Accredited through the National Association of Family Child Care (NAFCC)?
Yes Accredited Not Accredited
If "Not" - are you working toward NAFCC Accreditation? Yes No
Do you complete more than the required 10 hours of annual training? 
Yes I get more than 10 hours every year No I get just the required 10 hours
How many TOTAL clock hours of Early Childhood Education training during your child care career? 
60 -120 Hours  More than 120 Hours 

Do you have any college or higher level learning experience in Early Childhood Education (ECE)? 
Yes ECE experience No ECE experience
If "Yes" what is the highest level you have reached?
Some ECE classes, no degree  CDA  ECE Associate's 
ECE Bachelor's  ECE Master's or Advanced 
Other college or higher level learning experiences (non ECE)?
Medical Training Associates, Bachelors or Masters or other
Have you ever had any Training that addressed working with children who have special needs? Yes Training in special needs No Training in special needs
How many years of experience do you have providing Licensed/registered child care in your home? 
0 to 2 years 2 to 5 years 5 or more years
Do you have experience as a Parent? Yes Parent Not a Parent
Do you have experience in any of the following areas of working with children who have special needs:

 
ADD/ADHD Asthma/Breathing Cerebral Palsy
Hearing Impaired Visually Impaired Seizure Disorder
Autism Down Syndrome Bipolar
Sensory Integration
House is Physical Handicap Accessible
Other, please list
Do you or anyone on your staff speak a language other than English?
Yes other language No other language
If "Yes", what language?
School District: School District name:
Elementary School(s) children in your area attend: Please list the individual elementary school names:
Rates This information is used for statistical purposes only. Call for information about average rates in your area.
Full Time Part Time (Hourly Rates Only)
What do you charge for an Infant? Week  Day  Hour Hour
What do you charge for a Toddler? Week  Day  Hour Hour
What do you charge for a Preschooler? Week  Day  Hour Hour
What do you charge for a Kindergartner? Week Day Hour Hour
What do you charge for a School Ager? Week  Day  Hour Hour
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