Contact Information


Have questions while completing this update? Please call Charity McKinney at (336) 245-4900 or e-mail at cmckinney@ccrr.org

Questions with an Asterisk (*) in front of them are required.

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* How would you like your referral status to be listed in our database?  Even if you choose a "No Referral" status it is still important that we gather your child care data to track child care statistics throughout your county/region.

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* Program Name:

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* Director/Owner's Name:

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* Physical Location Address:

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* Mailing Address IF DIFFERENT from your location address (skip this question if your location address and mailing address are the same):

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* Primary Phone Number:

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* Secondary Phone Number (If Applicable):

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* Fax Number (If Applicable):

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* E-mail Address:

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* Are you okay with us listing your e-mail address on referrals?

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* Please List the Following for Your Program (If Applicable):

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