Group Day Care - Child Care Choices of Boston
[pic]FAMILY CHILD CARE PROVIDER PROFILE
Date Profile Completed: __________________ Completed By: _________________________
[pic]
General Info First Name: ___________________ Last Name: _________________________
Business Name: ______________________________________________________________________
(If applicable)
|Type of Care: |( Family Child Care | Date license first issued: |_____________________ |
When you have vacancies, do you want CCCB to refer parents to your program? Yes No
Location Address: __________________________________________________________________
(Do not put Post Office Boxes here.)
City: _______________________________________ State: ____________ Zip: ________________
Mailing Address: _______________________________________________________________________________
(If different from above.)
City: _______________________________________ State: ____________ Zip: ________________
Contact Primary phone: _____________________ Secondary phone: ___________________
Fax Number: _____________________ Email Address: _________________________
Website: __________________________________________________________________
License Information
Program # (ID): _____________________ Your Tax ID number: _____________________
License Number: _____________________ License Expiration Date: ____________________
What is the total licensed capacity for your program as stated on your EEC license: _________
If you choose to accept fewer children than your licensed capacity, what is the
maximum number of children you would enroll at any one time? _________
What is the total number of children currently enrolled full-time at your program: _________
(full-time is 30 or more hours per week)
What is the total number of current full-time vacancies (capacity – enrollment): _________
What ages of children will you accept at your program?
From: ____years ____months To: ____years ____months
(from the youngest you would accept to the oldest you would accept)
[pic]
Transportation: Please check any of the following that apply.
| Walking distance to school | Near public transportation | |
| One-way transportation provided | Two-way transportation provided | On school bus route |
Languages: Please check all languages spoken by you or your staff.
| English | American Sign Language | Amharic |
| Armenian | Cantonese | Chinese (Mandarin)Polish |
| Croatian | French | Greek |
| Italian | Khmer (Cambodian) | Laotian |
| Polish | Portuguese | Russian |
| Serbian-Cyrillic | Slovenian | Spanish |
| Vietnamese | Other: _____________ | |
| |
|Schedule Options: Please check all that apply to your program: |
| Part-week | Part day | Full day |
| 2nd Shift (approx 3pm-11pm) | 3rd Shift (approx 11pm-7am) | Sick care |
| Evening (after 6pm) | Overnight | Early day |
| Open school vacation weeks | Full week | Weekend |
| Flexible Schedule | Morning Session | Afternoon session |
| | |
|Are you subcontracted with a family child care system? |Yes No |
|If yes, check the appropriate System Agency below: (Check ONE only) |
| Associated Early Care & Education, Inc. | Clarendon Family Day Care |
| Bethel Child Care | Family Day Care Program, Inc. |
| Boston Chinatown Family Child Care | FDNH-Bartholomew |
| Child Care Project | Little Sisters of Assumption (Project Hope) |
| Child Development and Education, Inc. | JPNDC (Neighborhood Development Corp of Jamaica Plain) |
| Children’s Services of Roxbury | Viet Aid |
| Other:_______________________________________________________________________ |
|Do you also serve children outside the System (i.e. some private paying families)? | Yes No |
[pic]
Days Care Provided
|Is your program open: | Full year | School year only | Summer only |
|Do you accept children: | Both full-time | Full-time only | Part-time only |
| |and part-time |(30 or more hours per week) |(less than 30 hours per week) |
|Please check any of the following additional schedule options you offer: |
| | Before School | After School | Open Holidays |
| | Drop in | Rotating Schedule | 24-Hour Care |
| | Temporary/Emergency Care | |
|Please check the days that your provide care and indicate what time you open and close: |If you do an additional after school or evening schedule, |
| |please indicate it here: |
| | |Start Time |End Time |Start Time |End Time |
| |Monday |_______________ |_______________ |_______________ |_______________ |
| |Tuesday |_______________ |_______________ |_______________ |_______________ |
| |Wednesday |_______________ |_______________ |_______________ |_______________ |
| |Thursday |_______________ |_______________ |_______________ |_______________ |
| |Friday |_______________ |_______________ |_______________ |_______________ |
| |Saturday |_______________ |_______________ |_______________ |_______________ |
| |Sunday |_______________ |_______________ |_______________ |_______________ |
What do you charge for private paying (non-voucher) families based on the following age categories?
(You may attach a copy of published rates/documents you provide to parents outlining your fees.)
Check here if you do not have a private rate (i.e. you only take children with vouchers or through a system agency).
|Age Group |Full Time |Part-Time |
| |Weekly Rate |Hourly Rate (if applicable) |
|Infant |$_____________ per week |$_____________ per hour |
|(0-14 Months) | | |
|Toddler |$_____________ per week |$_____________ per hour |
|(15 Months-2 Years) | | |
|Preschool |$_____________ per week |$_____________ per hour |
|(over 2 years) | | |
|Part-time School Age |$_____________ per week |$_____________ per hour |
|(6-12 Years) | | |
Additional Fees
Please check and indicate amounts for any additional fees you may charge:
| Registration Fee | Late Fee | Extended Care Fee |
| Waitlist Fee | Materials Fee | Activities Fee |
Please use this space to make any special notes regarding the rates/cost for your program: _____________________________________________________________________________________
______________________________________________________________________________________________________
[pic]
Enrollment Information
|Please list the ages of all children currently enrolled FULL-TIME: |
|_______years_______months. |_______years_______months. |_______years_______months. |
|_______years_______months. |_______years_______months. |_______years_______months. |
|_______years_______months. |_______years_______months. |_______years_______months. |
| | |_______years_______months. |
|Please indicate if you have any part-time vacancies and for which age groups: | |_______years_______months. |
|Age Group |Part-time Vacancies |
|Infant (0-14 Months) |_____________ |
|Toddler (15 Months-2 Years) |_____________ |
|Preschool (over 2 years) |_____________ |
|School Age (6-12 Years) |_____________ |
[pic]
Attributes
Check here if you provide RESPITE care.
Environment: Please check all that apply.
| Accepts cloth diapers | Adult Pool | Air Conditioned |
| Approved Assistant | Cats | Dogs |
| Fenced Yard | Field Trips Taken | No pets |
| Other pets | Peanut Free | Smoke Free |
| Uses Public Playground | Wheel Chair Accessible | |
Meals: Please check all meals that are provided and/or what applies for your program.
| Breakfast | Morning Snack | Lunch |
| Afternoon Snack | Dinner | USDA Food Program |
| Special Meal Request | Parents Provide Food | Parents Provide Lunch |
Philosophy: Please check all that apply to your program.
| Academic Program | High/Scope Approach | Learning/Play |
| Montessori | Parent Cooperative | Piaget |
| Reggio Emilia | Religious Orientation | Resources for Infant Educarers |
| Waldorf | | |
Financial Assistance: Please check all types of financial assistance/subsidies offered at your program.
| Campership | Contracted Slots * | DCF Supportive Slots |
| Head Start | Private Scholarship | Sibling Discount |
| Sliding Fee Scale (private) | Teen Parent Slot | United Way |
| Vouchers | Other___________________ | |
* “Contracted” slots are slots that are subsidized by a contract with EEC to manage on a sliding scale fee dependent on income eligibility and a proven service need. They are NOT your regular slots and are managed by System Agencies.
Policies: Please check all that apply.
| Written Contract | Written Handbook | Provider Sick Allowance |
| Provider Vacation Allowance | Child Absence Allowance | |
Special Skills
Which of the following disability related services are available to children and their families in your program? Please check any that apply:
| Adaptive Equipment | Onsite Therapy | Onsite Medical Care |
| Onsite Nurse | | |
[pic]
Special Needs
Do you have experience working with children with disabilities/special needs? If yes, please check all that apply:
| Yes, I have experience | ADD/ADHD | Asthma/Allergies |
| At risk | Autism Spectrum Disorder | Behavioral special needs |
| Developmental special needs | Emotional/Social special needs | Feeding Tube |
| Hearing Impairment | Learning disabilities | Medical Condition |
| Monitors | Parental Incapacity | Physical special needs |
| Sensory Integration | Special Diet | Speech/Language |
| Visual Impairment | NO EXPERIENCE | Other |
Accreditation: Please check all that apply.
| NAFCC Accreditation, Expires: _____________________ |
| Other:___________________________________ |
Affiliations: Please check any that apply.
| Local FCC Association | Family Child Care System Agency | Religious |
| Hospital | College | Private School |
| Public School | CFCE | Other |
| Support Group Leader | | |
Do you use any of the following Child Assessment Tools? Please check all that apply:
| Ages & Stages | Creative Curriculum | High Scope Child |
| |Developmental Continuum |Observation Record |
| Work Sampling | Our Own Developed Assessment | Teaching Strategies Gold |
| Other:___________________________ | |
How often do you complete the above assessments?
| Annually | Twice a year | Quarterly |
| | | |
[pic]
Setting Please indicate the type of setting for your Family Child Care Home:
| House (single family) | Apartment | Townhouse |
| Mobile Home | Duplex | Non-Residential |
| Multi-family home | | |
Education
|Please check the highest level of education that you have achieved: |
| Degree related to health field | Degree related to special needs | LPN/RN |
| High School Education/GED | Degree related to ECE | Associate’s Degree |
| Bachelor’s Degree | Advanced Degree | CDA |
| Non-related degree | | |
Years of Experience
|Please indicate how many years of experience you have working in the Early Childhood Education field: |
| Under 1 Year | 1-3 Years | 4-9 Years |
| 10-20 Years | 21+ Years | |
Other Attributes
|Please check all that apply: |
| Assistant on call | Car used regularly | Dedicated indoor play area |
Census Bureau Statistics
|Please indicate your race/ethnicity (for statistical purposes only): |
| Spanish/Hispanic/Latino | White | Black or African American |
| American Indian or Alaska Native | Asian Indian | Native Hawaiian |
| Chinese | Filipino | Japanese |
| Vietnamese | Other:__________________________________________ |
Use this space to make any additional comments that will be useful for Information & Referral purposes:
_____________________________________________________________________________________
_____________________________________________________________________________________
Thank you for your time and cooperation!
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- boston college parents weekend
- boston catholic appeal official website for the catholic
- application for the harpoon championship of new england
- boston green academy reading
- bcm326 church in the city gordon college
- red sox and ny yankees
- applied ethics case of the month ttu
- minutes of the regular meeting april 23 2019
- group day care child care choices of boston
Related searches
- child care duties for resume
- sample child care worker resume
- maryland office of child care forms
- state of ct child care licensing
- division of child care and early education
- state of wisconsin child care forms
- state of ct day care licensing
- state of nevada child care licensing
- office of child care maryland forms
- office of child care regulations
- types of child care curriculum
- state of louisiana child care licensing