Center & Family Whole Record Update

Contact Information

What type of facility are you?*

General Information

Do you want your program to be on our referral list?*
What is the youngest age of children you will accept?*
What is the oldest age of children you will accept?*
How many caregivers work in your program (not including volunteers, cooks, drivers, housekeepers)?*

Days Care Provided

Do you accept children full time, part time, or both full time and part time?*
Do you offer care 24 hours a day?*
Do you offer after school care for school age children?*
Do you offer care after school (on days children are released early for school age children)?*
Do you offer before school care?*
Do you provide drop in care (accept child for a short period of time on short notice)?*
Do you offer care on graveyard shift*
Do you provide care for a child who is mildly sick?*
Do you provide care on occasion in the evening or overnight?*
Are you willing to offer care on an occasional Saturday?*
Are you willing to offer care on an occasional Sunday?*
Are you open on school holidays that are not State/National Holidays?*
Are you open on State/National Holidays?*
Do you only care for relatives?*
Do you provide care for families that work rotating shifts?*
Do you provide care on Saturdays?*
Do you provide sick care?*
Do you provide care on Sundays?*
Do you provide care for families that work swing shifts (4pm - 12 am)?*
Do you provide care in a temporary situation or in an emergency?*
Do you provide care year round?*

Days and Hours

Capacity

0-11 Months
12-23 Months
2 Years
3 Years
4-5 Years
Kindergarten
School-Age
Total Number of Full Time Vacancies
Total number of vacancies for children 23 months and younger*
Total number of vacancies for children 2 years old and older*

Facility Information

Number of diapering tables?*
Location of diapering tables?*
Number of restrooms?*
Do you have restrooms in all 2 years old and older classes?*
Number of playgrounds?*
Names of playground(s) and ages that use them:*
Do you have a Activity/Gym area?*

Enrollment and Rates

0-11 Months
Current Number of Children Enrolled
Monthly Rate*
12-23 months
Current Number of Children Enrolled
Monthly Rate*
2 Years
Current Number of Children Enrolled
Monthly Rate*
3 Years
Current Number of Children Enrolled
Monthly Rate*
4 Years
Current Number of Children Enrolled
Monthly Rate*
5 years (Pre-K)
Current Number of Children Enrolled
Monthly Rate*
Kindergarten - in school
Current Number of Children Enrolled
Monthly Rate*
Kindergarten - out of school
Monthly Rate*
School Age - in school
Current Number of Children Enrolled
Monthly Rate*
School Age - Out of School
Monthly Rate*

Special Needs

Do you have experience, training, or are willing to be trained with any of the following special needs?

Languages

Please mark all the languages spoken in your program:*

Environment

Do you accept state child care subsidy?*
There is Public Transportation (UTA) near my facility.*
I have pets that interact with the children in my program.*
I never allow smoking on the premises including after hours.*
I offer an educational preschool program for 3-5 year olds.*

National Accreditation

Please mark the organization by which your program is nationally accredited:

Other Information

Would you like this information to show on your Care About Childcare Marketing Page?
Would you like one of our staff members to contact you and help you get started on your Marketing Page and Quality Indicators to showcase the quality in your program?
If you need to update other information or have questions about this form, please contact our office at 801-355-4847 or 866-438-4847 - Monday through Thursday 8:30 AM - 5:00 PM(MST)
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