* 1. First and last name

* 2. What is your facility number?

* 3. What is the best phone number for you to be reached at?

* 4. What is your email address?

* 7. What are your scheduled days and hours of operation?

* 8. Do you take in children for full-time, part-time or both?

* 9. What are your full-time rates? (Fill in all that apply)

* 10. Do you have any special needs experience?

* 11. Do you provide transportation for the children?

 

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