Child Care Intake

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211 Child Care is a free, confidential and statewide service which helps match the requests of parents with child care providers and programs. We receive over 40,000 calls a year from families searching for child care. We are reaching out to you to obtain information that would help parents learn about your program.

We will gather your information such as your fees, program hours, openings, meals served , languages spoken, etc.

We look forward to learning about your program!

License Prefix(Required)

Definitions

DCCC – Child Care Centers

DCFH – Family Homes

DCGH – Group Homes

DCEX – License Exempt Program

EXEMPT – Exempt Program

License Number(Required)

Your Name

Your Email

Program Name

or Doing Business As (DBA) Name

Scheduling Information

Are you open?

Year Round

School Year

Summer Only

What days are you open? Check all that apply

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Are you open for the same hours each day?

Yes

What are your hours?

What are your hours? (To add hours for additional sessions, click on the plus sign.)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Is there anything you want us to know about your hours?

Program Information

Tell us about your program (Description, Mission Statement, Philosophy, Important Information)

Website or Social Media Address

What elementary school are you nearest to? (To add multiple schools, click on the plus sign. )

What languages are spoken? (To add multiple languages, click on the plus sign.)

Does your program offer meals/snacks?

Yes

Check all that apply

Breakfast

Lunch

Dinner

Morning Snack

Afternoon Snack

Evening Snack

Gluten-free diet available

Dairy-free diet available

Nut-free facility

Peanut-free facility

Are your enrolled with the Child and Adult Care Food Program (CACFP)?

Yes

The Child and Adult Care Food Program (CACFP) is a federal program through the U.S. Department of Agriculture (USDA). The CACFP provides nutritious meals and snacks to infants and children in child care centers, family day care homes, and emergency shelters; and snacks and suppers to children participating in eligible at-risk afterschool care programs.

Do you or any staff members have any special needs experience?

Yes

Check all that apply

ADD/ADHD

Asthma/Respiratory Problems

Autism

Autism Spectrum Disorder

Behavioral Problems

Cancer

Cerebral Palsy

Cleft Lip/Palate

Cystic Fibrosis

Developmental Delays

Down Syndrome

Epilepsy

G-Tube

Hearing Impairment

Learning Disability

Mental Health Impairment

Multiple Sclerosis

Muscular Dystrophy

Neurological Disorder

Parapalegia/Quadrapalegia

Physical Disabilities

Siezure Disorders

Sickle Cell

Social Emotional Disturbance

Speech/Language Impairment

Spina Bifida

Tourrette Syndrome

Visual Impairment

Do you have an Office of Early Childhood (OEC) approved assistant?

Yes

An OEC approved assistant is defined as someone 18 years or older who has been approved by the commissioner. These forms can be obtained through OEC.

Do you have: (Check all that apply)

A pool

A fenced in yard

Pet free environment

Someone who smokes in your home

Web camera access

What is the educational experience of staff in your program? (Check all that apply)

High School Diploma

Bachelors Degree

Masters Degree

Doctorate

CDA (Child Development Associate)

Early Childhood Education

Elementary Education

Special Education

Does your program follow a special curriculum?

Art-based

Play-based

Community-based

Montessori

Co-op

Academic

Regio Emilia

Waldorf

Openings

Do you have any openings?

Yes

How many FULL TIME Infant (0-17 months) openings?

How many FULL TIME Toddler/Preschool (18 months -5 years 11 months) openings?

How many FULL TIME Toddler (18-35 Months) openings?

How many FULL TIME Preschool (3 year -5 years, 11 months) openings?

How many FULL TIME School Age (Before/After School) openings?

Enrollments

Do you have any children enrolled?

Yes

How many FULL TIME Infant (0-17 months) are enrolled?

How many FULL TIME Toddler/Preschool (18 months -5 years 11 months) are enrolled?

How many FULL TIME Toddler (18-35 Months) are enrolled?

How many FULL TIME Preschool (3 year -5 years, 11 months) are enrolled?

How many FULL TIME School Age (Before/After School) are enrolled?

Fees

Would you like to share your weekly fee information for each program (i.e. how much do you charge families on a weekly basis per child?)

Yes

This information will be published on our search engine as part of your profile.

Do you accept Care 4 Kids Subsidy?

Yes

For more information, please visit www.ctcare4kids.com

All providers who receive a Care 4 Kids subsidy are required to complete the Federal Health and Safety Orientation Training and Ongoing Professional Development to build their knowledge and skills. To learn more information, visit https://www.ctcare4kids.com/provider-information/providertrainingrequirements/

Do you offer any discounts?

Sibling Reduction

Membership Discount

Scholarships

Military Discount

Resident Discount

Other

What do you charge WEEKLY for FULL TIME care for an INFANT? If you are OEC funded, provide your private pay, non-funded rate?

What do you charge WEEKLY for FULL TIME care for an TODDLER? If you are OEC funded, provide your private pay, non-funded rate?

What do you charge WEEKLY for FULL TIME care for an PRESCHOOL? If you are OEC funded, provide your private pay, non-funded rate?

What do you charge WEEKLY for FULL TIME care for an SCHOOL AGE? If you are OEC funded, provide your private pay, non-funded rate?

What do you charge WEEKLY for FULL TIME care for an INFANT?

What do you charge WEEKLY for FULL TIME care for an TODDLER/PRESCHOOL?

What do you charge WEEKLY for FULL TIME care for an SCHOOL AGE?

Do you have any questions or comments for 211 Child Care?

Thank you for taking the time to complete this intake survey!

Si prefiere completar la encuesta en español, haga clic aquí.

Scheduling Information

Program Information

Openings

Enrollments

Fees