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* 1. First and last name

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

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* 3. What is your email address?

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* 4. What is your facility number?

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* 7. Do you take in children for full-time, part-time, drop-in, rotating schedule? Select all that apply.

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

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* 9. Do you provide transportation to school?

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* 10. What are your full-time rates? (Fill in all that apply) We don't share your rates to parents but we use them for reports.

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* 11. Do you have any special needs experience?

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* 12. Which languages do you or your staff speak?

 

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