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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* If you would like to include a message to families that will show up on referrals about your program please type that in this space:

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* If you have a logo for your program you can download it here to show up on your program profile.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File

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* If you have a brochure or registration form you can upload it here and we will upload it to your profile in the database.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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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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* Director/Owner's Name:

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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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