Cumberland County's Child Care Resource Development Center
Fill out the following form to register your program with Child Care Connections. If you’re already registered with us, you may use this form to update your information.
* First Name:
* Last Name:
Job Title:
Program Name:
* Address:
Address Line 2:
* City:
* State:
* Zip Code:
Directions to your site:
How long have you been in operation? Month and Year:
* Phone (with Area Code):
Email:
Fax:
* Type of Program: Center Family Child Care School-Age Program Nursery School/Preschool Camp Other
If Other, Please Explain:
* Ages of Care (Check All That Apply): Infant Toddler Preschool Kindergarten School Age Other
Total Capacity:
License Expiration Date:
Schedule of Care Hours: Full time Part time Both Other
Hours and Days of the Week the Program Is Open: Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:
Sessions: Year Round School Year Only Summer Only Other
Do you offer Weekend or Evening Care:
What are your weekend and evening rates?
Are meals provided? Yes No
If so, which ones?
Do you have any pets? Yes No
If yes, what kind of pets?
Do you use a written agreement (contract) with parents? Yes No
How many vacations do you take per year?
Are they paid or unpaid? Please check: Paid Unpaid Some paid, some unpaid
Transportation:
Is transportation provided? Yes No
Is the program close to public transportation? Yes No
If so, what kind?
Is the program near school bus routes? Yes No
Elementary School(s) You are on these bus route:
Approximate Distance:
Fees: Hourly Daily Weekly Monthly Yearly Other
Please list your full-time fees according to age group.
Please list your part-time fees according to age group (if applicable).
Do you offer a sibling discount? Yes No
If so, please explain.
Please list all forms of financial assistance that you offer or accept.
Staff Training and Experience:
Are All Staff/Providers Trained In CPR? Yes No
Are all staff trained in First Aid? Yes No
Please describe staff education, degrees, and experience.
Please describe staff experience with special needs.
Is there anything else about your program that you would like us to know?
Do you current have openings? Yes No
If you have openings, please indicate what age you have openings.
Please indicate how many infants, toddlers, preschoolers, and school-age children do you currently have enrolled?
Thank you for taking the time to complete this form. Please click the Submit Form button to send us your information. We will be contacting you soon.
Contact info: 136 U.S. Route One Scarborough, ME 04074 207-396-6566, ext. 574
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