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Add Me on the Child Care Referral Database

LICENSED FAMILY CHILD CARE PROVIDER SURVEY

If you are a licensed family child care provider and would like to be added to the Santa Clara County Resource and Referral database, please provide the following documents:

1. FCC New Provider Survey
English version available here
Spanish version available here

2. A copy of your current child care license
3. A copy of your rate sheet

You may FAX these documents to 408-487-0762 Attention: R&R Department

OR

You may MAIL these documents to:
4C Council
150 River Oaks Parkway, #F-1
San Jose, CA 95134
Attn: R&R Department

OR

You may complete the below application and upload a copy of your license.


Country
Address Line 1
Address Line 2
City
State
Postal Code
Country
Address Line 1
Address Line 2
City
State
Postal Code


Do you provide transportation for school age children?
Vacancies (child care openings)
Number of openings for Infants
Number of Openings for Preschool Age 2-5
Number of Openings for School Age 6 and older
Are you willing to accept Child Care Subsidy Payments? Check all that apply.
Days Open for Child Care (Check all that apply)

Hours

Infants

Infant Full-Time Cost
Per Week
Infant Part-Time Cost
Per Week

Toddlers

Per Week
Per Week

Preschool

Preschool Age Full-Time Cost
Per Week
Preschool Age Part-Time Cost
Per Week

School Age

School-Age Full Time Cost
Per Week
School Age Part-Time Cost
Per Week
Do you offer a Sibling Discount?
$
$
$
Type of Schedule (Check all that apply)
Check all that Apply to your Family Child Care Home
Meals Served
Program
Philosophy
Education

Special Needs

Experience
Education
Specific Needs
Religious Affiliation
Tell us about the Quality Improvement Programs you are part of:

Do you wish to be referred to parents?
Day Care License
No file selected
Rate Sheet
No file selected

 

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