Fall 2024 Provider Update Form/Road Trip

Your Name

First NameLast Name

Thank you for taking a few minutes to share about your program.

Child Care Program Name

K8#

Does your program have a website? If so, please share the link.

Center Director or FCCH Owner's Name

First NameLast Name

Child Care Program Email

example@example.com

Child Care Program Phone Number

Area CodePhone Number

PHYSICAL Address (if different than mailing)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Age range you offer care for?

How many children total are currently enrolled in your program?

Do you accept? *click all that apply

How many INFANTS in your care are private pay?

How many TODDLERS in your care are private pay?

How many 2 YEAR OLDS in your care are private pay?

How many 3 YEAR OLDS in your care are private pay?

How many 4 YEAR OLDS in your care are private pay?

How many 5 YEAR OLDS in your care are private pay?

How many SCHOOL AGE children in your care are private pay?

What are your FULL TIME PRIVATE PAY WEEKLY rates for Infants (0-12mo)?

What are your FULL TIME PRIVATE PAY WEEKLY rates for Toddlers (12mo-24mo)?

What are your FULL TIME PRIVATE PAY WEEKLY rates for 2yo?

What are your FULL TIME PRIVATE PAY WEEKLY rates for 3yo?

What are your FULL TIME PRIVATE PAY WEEKLY rates for 4yo?

What are your FULL TIME PRIVATE PAY WEEKLY rates for 5yo?

What are your FULL TIME PRIVATE PAY WEEKLY rates for School Age (6+)?

What days of the week do you provide care?

What are your daily hours of operation?

If you offer transportation, please list the schools you transport to/from:

Do you offer care for children with special needs?

Other

Do you or any of your staff speak fluent Spanish?

Other

Do you participate in CACFP aka "The Food Program" - if so, which one?

How many OPENINGS do you currently have for INFANTS?

How many OPENINGS do you currently have for TODDLERS?

How many OPENINGS do you currently have for 2yo?

How many OPENINGS do you currently have for 3yo?

How many OPENINGS do you currently have for 4yo?

How many OPENINGS do you currently have for 5yo?

How many OPENINGS do you currently have for School Age (6yo+)?

What do you love about Great Plains Child Care Resource & Referral?

Thank you for taking the time to complete this form!

We appreciate all you do!

Rachel, Lisa, Jennifer, Athena & Emmy