**NEW** CENTER Add-a-Site APPLICATION

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Image Field
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Corporation Name* This field is required.(DBA Little Baby's Learning Academy)
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Center Name* This field is required.(DBA Little Baby's Learning Academy)
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Business Formation Type* This field is required.
Please Select
Please Select
Corporation
LLC
Private Non Profit
Inc.
Limited Partner
Sole Proprietorship
Church Affiliated
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Tax ID # or Social Security #* This field is required.EIN/FEIN
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Program Type* This field is required.
Please Select
Please Select
Child Care Center
At-Risk Afterschool Program ONLY
Adult Care Center
Homeless Shelter
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Profit Status* This field is required.
Please Select
Please Select
For Profit Corp/LLC/Partner
Non-Profit
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Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Center's Telephone Number* This field is required.
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Mobile Number
Please enter a valid phone number.
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Alternate Telephone Number* This field is required.
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Fax Number
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E-mail* This field is required.
example@example.com
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Website
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Licensing Agency* This field is required.
Please Select
Please Select
Bright From the Start (CCDivision)
Department of Community Health
Head Start
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License Number* This field is required.If Applicable
Type Exempt if Exempt from License
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License Capacity* This field is required.
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Center Enrollment Number* This field is required.
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County* This field is required.
Please Select
Please Select
Appling County
Atkinson County
Bacon County
Baker County
Baldwin County
Banks County
Barrow County
Bartow County
Ben Hill County
Berrien County
Bibb County
Bleckley County
Brantley County
Brooks County
Bryan County
Bulloch County
Burke County
Butts County
Calhoun County
Camden County
Candler County
Carroll County
Catoosa County
Charlton County
Chatham County
Chattahoochee County
Chattooga County
Cherokee County
Clarke County
Clay County
Clayton County
Clinch County
Cobb County
Coffee County
Colquitt County
Columbia County
Cook County
Coweta County
Crawford County
Crisp County
Dade County
Dawson County
Decatur County
DeKalb County
Dodge County
Dooly County
Dougherty County
Douglas County
Early County
Echols County
Effingham County
Elbert County
Emanuel County
Evans County
Fannin County
Fayette County
Floyd County
Forsyth County
Franklin County
Fulton County
Gilmer County
Glascock County
Glynn County
Gordon County
Grady County
Greene County
Gwinnett County
Habersham County
Hall County
Hancock County
Haralson County
Harris County
Hart County
Heard County
Henry County
Houston County
Irwin County
Jackson County
Jasper County
Jeff Davis County
Jefferson County
Jenkins County
Johnson County
Jones County
Lamar County
Lanier County
Laurens County
Lee County
Liberty County
Lincoln County
Long County
Lowndes County
Lumpkin County
McDuffie County
McIntosh County
Macon County
Madison County
Marion County
Meriwether County
Miller County
Mitchell County
Monroe County
Montgomery County
Morgan County
Murray County
Muscogee County
Newton County
Oconee County
Oglethorpe County
Paulding County
Peach County
Pickens County
Pierce County
Pike County
Polk County
Pulaski County
Putnam County
Quitman County
Rabun County
Randolph County
Richmond County
Rockdale County
Schley County
Screven County
Seminole County
Spalding County
Stephens County
Stewart County
Sumter County
Talbot County
Taliaferro County
Tattnall County
Taylor County
Telfair County
Terrell County
Thomas County
Tift County
Toombs County
Towns County
Treutlen County
Troup County
Turner County
Twiggs County
Union County
Upson County
Walker County
Walton County
Ware County
Warren County
Washington County
Wayne County
Webster County
Wheeler County
White County
Whitfield County
Wilcox County
Wilkes County
Wilkinson County
Worth County
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Nearest Elementary School to the Center* This field is required.
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Authorized Representative* This field is required.
First Name
Last Name
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Position
Director
Owner
Assistant Director
Lead Teacher
Cook
Other
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Date of Birth* This field is required.
Date
Month
Day
Year
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Valid Driver License/ID* This field is required.
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Select files to upload
Max. file size: 10.6MB
Browse Files
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Check Days of the week that meals will be served
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Center Operating HoursOpen Time Until Close Time
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Breakfast Time
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Hour
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AM Snack Time
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Hour
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Lunch Time
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Hour
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PM Snack Time
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Hour
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Hour
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Dinner Time
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Hour
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Minutes
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Until
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Hour
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Evening Snack Time
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Hour
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Minutes
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Until
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Hour
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How are the meals preparedFood Service
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Agency License (ie, Bright From the Start, DCH)
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Max. file size: 10.6MB
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NO PHOTOS PLEASE
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Deed or Lease of facility with Legal Name
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Max. file size: 10.6MB
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NO PHOTOS PLEASE
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Original IRS letter assigning FEIN to entitles legal business name* This field is required.
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Max. file size: 10.6MB
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Fire Inspection Report (Most Recent)* This field is required.
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Max. file size: 10.6MB
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NO PHOTOS PLEASE
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Certificate of Occupancy
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Max. file size: 10.6MB
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NO PHOTOS PLEASE
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501(C)3 Letter (ONLY for NON-PROFIT CENTERS)
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Max. file size: 10.6MB
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NO PHOTOS PLEASE
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Roster of ALL Enrolled participants with Age/DOB * This field is required.
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Max. file size: 10.6MB
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NO PHOTOS PLEASE
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* This field is required.
Should be Empty: