Provider/Center Whole Record Update Form

Thank you for spending your precious time to help us collect this important data! The data we collect links your program´s general information tab on Care About Childcare. This website is where parents can find quality childcare in Utah.
Instructions: Please fill in the blank or place a check mark next to items that apply to your program.

*required fields

GENERAL INFORMATION
*First Name: *Last Name:
*Business Name:
LOCATION
*Street Address (Please list the coordinates of any street names):
*City: *State: *Zip Code:
MAILING ADDRESS
(If different than Location Address)
Address:
City: State: Zip Code:
CONTACT
*Primary Phone: Secondary Phone:
Fax: E-mail:
Website:
Would you like us to list your e-mail address for the purpose of receiving e-mail from parents and information that affects your program from Child Care Resource & Referral, The Office of Child Care, and the Department of Workforce Services? Yes    No
CAPACITY ACCEPTED AGE RANGE
(Regardless of current openings)
*How many children are you licensed for?: *What is the youngest child´s age you accept?:
*What is your desired capacity?: *What is the oldest child´s age you accept?:
*How many total vacancies do you have?:
POPULATION INFORMATION
List your daytime full-time and part-time vacancies for each age group

*Vacancies *Number of Children
Enrolled in your program		 *Number of Rooms
for each age group
-Center Only		 *Licensed capacity
for each age group
*0-11 months * * Infant & Toddler


Preschool & Kindergarten


Grades 1-6


Grades 6-9


 *Infant & Toddler


*Preschool & Kindergarten(+)


Grades 1-6 (Center Only)


Grades 6-9 (Center Only)
1 years * *
2 years * *
3 years * *
4 years * *
5 years (not in kindergarten) * *
Kindergarten - in school * *
School Age - in school * *
*Please take the time to fill out the enrollment column this data is collected statewide and very important.
*RATES
List your daytime full time rates for each age group. You do not have to fill in every column.
*This information is used for statistical purposes only and to help us advocate the needs of providers. No rate information is ever identified with any individual provider.

Monthly FT Rate Weekly FT Rate Daily FT Rate Hourly FT Rate
0-11 months
1 years
2 years
3 years
4 years
5 years (not in kindergarten)
5 years - in school
5 years - out of school
School Age - in school
School Age - out of school
DAYS AND HOURS
(Please enter the start and end time for the days which care is provided)

Start Time End Time
Monday * *
Tuesday * *
Wednesday * *
Thursday * *
Friday * *
Saturday
Sunday
*SCHEDULE INFORMATION
I accept children: Full Time (40 hours or more per week)    Part Time (less than 40 hours per week)
I provide 24 Hour Care I provide care for Occasional Evening/Overnight
I can provide care for a 4/10 Schedule
   (6:30am-7:00pm M-TH)		 I provide care for Occasional Saturday
I provide care After School I provide care for Occasional Sunday
I provide care After School on days school is out early I provide care on School Holidays
I provide care Before School I provide care on State/National Holidays
I provide care on a Drop In basis I only provide Relative Care
I provide care during a Graveyard Shift
   (midnight-6:00am)		 I provide care for Rotating Shift
I provide care for KIC (Kids in Care) I provide care on Sunday
I provide care for kids that are Mildly Sick I provide care on Saturday
I provide Sick Care I provide care during a Swing Shift
   (7:00pm - midnight)
I provide care on a Temporary or Emergency Basis
*SPECIAL NEEDS
Do you feel like because of your education and/or experience you have a comfort level with children with disabilities in this area?
Please check all that apply to your program
ADHA/ADD Feeding Tube
Allergies Hearing Impairment
Asthma Learning Disability
Autism Multiple Sclerosis
Blindness/Visual Impairment Muscular Dystrophy
Cerebral Palsy Orthopedic Disabilities
Developmental Delays Oxygen Therapy
Diabetes Seizures
Down Syndrome Spina Bifida
Emotional/Behavioral Wheel Chair Accessible
Epilepsy Other: 
*ELEMENTARY SCHOOLS
Please list any elementary and middle schools, both public and private, that you service.
List School Below Check which applied to each school you list
If you serve more than 3 schools please list in comment box on the last page the others.
There is a bus stop close to my house
I provide transportation to and from school
The children walk to and from school
Other:
There is a bus stop close to my house
I provide transportation to and from school
The children walk to and from school
Other:
There is a bus stop close to my house
I provide transportation to and from school
The children walk to and from school
Other:
*ENVIRONMENT
Do you offer an educational preschool program for 3-5 year olds?Yes    No
 There is a Public Transportation (UTA) near my facility.
I have pets in my program
What pets do you have? 		I provide a smoke free environment (no one smokes in the facility during or after business hours.)
*LANGUAGES
Please check all that apply to you or a staff member
English Non English Sign Language Spanish Other:
I would like to be on CCR&R Spanish Mailing List? Yes    No
*AFFILIATION
Place a check mark by any profession organizations you belong to
PFCCA AUA NAEYC
UAEYC USACA NAFCC
UPCCA NAA NCCA
*ACCREDITATION
Check the organization by which your program is nationally accredited
NAEYC NECPA NSACA NAFCC
NAEYC in process NECPA in process NSACA in process NAFCC in process
GENERAL COMMENTS
Please use this space to provide other information about your program you would like us to know or share with parents.
CARE ABOUT CHILDCARE - MARKETING PAGE
Everyone benefits from quality child care parents, providers, and most importantly, children. Care About Childcare is an exciting new online program that the Utah Office of Child Care created in partnership with parents, child care providers, and many other early childhood stakeholders. More than a website, this system helps child care providers showcase the quality in their programs, and gives parents information that will allow them to make good choices for their families. The program does this by matching a family’s specific needs to a child care provider’s specific strengths. The website also provides links to child care and child development resources. (www.careaboutchildcare.utah.gov)
*Have you completed your Marketing Page? Yes    No
*Have you finished the specific number of Quality Indicators needed for the CAC/Lakeshore Grant? Yes    No
*Have you submitted and receive the CAC/Lakeshore Grant? Yes    No
*Would you like one of our staff members to contact you and help you get started on your Marketing Page and the Quality Indicators needed for the CAC/Lakeshore Grant? Yes    No
*Funding is limited, and awarded on a first come, first serve basis
      
Child Care Resources & Referral : 801.863.8589
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