CAREReady Provider Application

CAREReady Provider Application

Complete your daycare/afterschool program and staffing details to be considered for CAREReady ATL enrollment.
Organization Information
Legal Business Name
Doing Business As (DBA)
Physical Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City
ZIP Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Website
Owner Name

First NameLast Name
Director/Administrator Name

First NameLast Name
Director/Administrator Email
example@example.com
Billing Contact Name

First NameLast Name
Billing Contact Email
example@example.com
Program Information
Program Type

Other
DECAL License Number (if applicable)
Ages Served
Staffing Needs
Services Needed
Staffing Frequency
How frequently do you need substitute staff?
How much notice do you usually have before needing staff?
Agreement
I confirm the information provided is accurate.
I understand CAREReady assignments are subject to worker availability and applicable verification.
Should be Empty: