Date __________ Facility Name__________________ Address________________________
Telephone Number __________________ Director Name ______________________________
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How many years have you been in business? _________________________________
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Are you licensed with the state? Yes/No
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If yes, what is your license number? _________________________________________
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If no, do you belong to any professional accreditation organizations? Yes/No
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If yes, do you currently have any violations? Yes/No
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If yes, what are they and what are you doing to resolve them?______________________
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If no, when was the last time your facility was inspected? _________________________
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What age groups of children do you serve? ____________________________________
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What are your hours of operation? ___________________________________________
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How much is your cost for care monthly? ______________________________________
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What does this cost include? _______________________________________________
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Are there any additional costs? Yes/No
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If yes, what are they and how much? _________________________________________
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Is financial assistance available? Yes/No
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Do you provide meals or snacks? Yes/No
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If so, what are they? ______________________________________________________
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What is your child/teacher ratio? ____________________________________________
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What is the total number of children for whom you currently provide care for? __________
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Are you closed for any periods of time throughout the year? _______________________
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If so, when are you closed? ________________________________________________
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Can I drop in anytime during business hours for a visit to see the facility?Yes/No
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Do you offer references? Yes/No
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If yes, can I have that information? ___________________________________________
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What is the daily routine and types of activities planned for the children? ______________
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What are your methods for discipline? ________________________________________
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Do you provide transportation? Yes/No
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If so, from what time to what time & how for what distance? ________________________
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Do you currently have any openings for my child/children? Yes/No
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If no, do you have a wait list? Yes/No
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If yes, can I be added to your wait list? Yes/No