Please complete all of the information requested - Thank You!!
| CONTACT INFORMATION |
| Center Name: | |
| Director's Name: | |
| Address: | |
| City: | |
| State: | |
| Zip: | |
| County: | |
| Type of Care: | |
| Facility Setting: | |
| Phone: | |
| Fax: | |
| Email: | |
| Website: |
| License ID#: | |
| License Type | Ohio
Department of Job & Family Services (JFS) Ohio Department of Education (ODE) |
| Licensed Total Capacity: |
| Capacities by Age Group |
Licensed Capacity |
Desired Capacity |
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| School-age (5 years and over, in school) |
| Hours of Operation | Open at:
Close at: |
| Days of the Week facility is open for care |
| Monday | Tuesday | Wednesday | Thursday | Friday | Saturday | Sunday |
| Is the facility open for Holidays? | If explanation is needed: |
| Accepted Age Range of children for care | Youngest:
Oldest: |
| Do you accept children that are?: |
| Full-time only | |
| Part-time | |
| Both, full-time and part-time |
| Elementary School District(s) - provide all of the schools your facility has transportation to and from for school-aged children |
| Programs offered within facility |
| Preschool | 1/2 Day Kindergarten SAC | Kindergarten | Summer SAC | School Year SAC | Head Start | Sick Child Care |
| Environment |
| Non-smoking | No pets | Pets; Specify: | Fenced yard | Wheelchair accessible | Gym | Computer access |
| Meals offered within facility |
| USDA Food Program | Breakfast | AM Snack | Lunch | PM Snack | Supper | Parent Provided | Special Diet |
| Special Needs, staff must have training and/or experience |
| Emotional / Behavioral | Medical Conditions | Speech / Hearing | Physical / Mobility | MR/DD | Visual | Allergies / Asthma |
| Special Services offered within facility |
| MR/DD | Early Head Start | Head Start - Enhanced | Head Start - Stand Alone |
| Accreditation, Is the facility accredited with any of these organizations? |
| NAFCC | NAEYC | NSACCA | Other: |
| Policies |
| Interview required | Written contract | Written policies | Child must be toilet-trained |
| Financial Assistance |
| Publicly Funded Child Care (PFCC) through County Job & Family Services | |
| Sliding Scale | |
| Multi-child discount |
| RATES | Hourly Full-time |
Hourly Part-time |
Weekly Full-time (45 hrs) |
Weekly Part-time |
Further explanation of rates by age group |
| Infant (0-17 months) | $ | $ | $ | $ | |
| Toddler (18-35 months) | $ | $ | $ | $ | |
| Preschool (3-5 years, not in school) | $ | $ | $ | $ | |
| School-age (5 years and over, in school) | $ | $ | $ | $ |
| Additional Fees (check which of the following apply) |
| Registration / Application Fee | Deposit | Supply Fee | Meal / Snack Fee |
| Do your staff have any of the following benefits? (check all that apply) |
| Paid vacation time | Paid sick time | Paid personal time | Paid holidays | Health insurance | Life insurance | Retirement plan |
| Specify the number of staff in each ethnicity |
| White | Black | American Indian | Chinese | Vietnamese |
| Asian Indian | Japanese | Filipino | Other |
| How many of your staff speak another language besides English at home? |
| What other language(s) are spoken in the homes of your staff? |
| CURRENT VACANCIES | TOTAL | CURRENT ENROLLMENT | TOTAL |
| Infant (0-17 months) | Infant (0-17 months) | ||
| Toddler (18-35 months) | Toddler (18-35 months) | ||
| Preschool (3-5 years, not in school) | Preschool (3-5 years, not in school) | ||
| School-age (5 years and over, in school) | School-age (5 years and over, in school) |
You have completed our on-line Center Update form. Thank you!!
Keep in mind, we will continually be updating our database with this information.
Thank you again for your help and for taking the time to complete our form!!
Do you have questions?, if so call us at 1-800-92CHILD or email acrose@childcarechoices.org!!