1. Default Section

The following survey is an alternative to updating your child care profile over the phone. If you prefer over the phone, you may call the 4C office at 812-423-4008, option 3 and complete the update over the phone.

If you have more than one child care, please fill out a separate survey for each child care.

If you have any problems filling out the survey, please call our office at 812-423-4008, option 3 or Ashley Hansen ext. 108. You may also e-mail Ashley at ahansen@child-care.org.

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* 1. Enrollment Contact of Child Care and Child Care Business Name. Enrollment contact is the person that families looking for child care will contact.

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* 2. Type of Care:

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* 3. Would you like 4C to include your child care in referrals to parents?

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* 4. Location/Mailing Address and Contact Information of Child Care

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* 5. License Type

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* 6. Capacity. License Capacity is the capacity on your license. If your facility is not licensed, leave this blank.

Desired Capacity is the total number of children you desire to have in your child care. This number may be lower than License Capacity.

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* 7. Accepted Age Range

  Age
Lowest Age Accepted
Highest Age Accepted

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* 8. Hours of Child Care. If you have more than one shift, please indicate the time the child care opens until the time the child care closes. If child care is 24 hours, start time is 12:00am and end time is 11:59pm.

  Number of Shifts Start Time End Time
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

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* 9. Accepts Children:

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* 10. Rates (based on ages of children). 

  Weekly Rate, Part Time Weekly Rate, Full Time
School Age Children (Summer and Holidays)
0-12 Months
13-23 Months
24-35 Months
3-4 Years
5 Years
Kindergarten
Before and After School

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* 11. Capacity/Vacancy/Enrollment Information by Age. Please only fill in answers for ages of children your child care accepts. Leave all other ages blank.

  Full Time Vacancies Part Time Vacancies # Enrolled
School Age Children (Holidays and Summer)
0-12 Months
13-23 Months
24-35 Months
3-4 Years
5 Years
Kindergarten
Before and After School

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* 12. Paths to Quality Level

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* 13. Is your program accredited? 

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* 14. Child and Adult Care Food Program (CACFP) Participation:

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* 15. Select any of the following financial assistance options your program offers to families:

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