Skip to main content

Add Me on the Child Care Referral Database

CHILD CARE CENTER SURVEY

If you have Multiple Sites, please complete One(1) form for each site.

Please complete all applicable information.


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

Infant (0-23 mon.)
Infant License #
Infant Capacity (0-1yr11m)
Preschool (2-5 yr.)
Preschool License # (2-5 yr.)
Preschool Capacity (2-5yrs)

Toddler Option

Toddler Option License Number
Toddler Option Capacity

School Age Option

School Age Option License Number (if applicable)
School Age Option Capacity (if applicable)
School Age (Kinders & Older)
School Age License #
School Age Capacity (if applicable)
Maximum Number of Children You Will Serve In Your Program
Ages of Children You Will Serve

Do you provide transportation for school age children?
Are you located on the school grounds?
Vacancies (child care openings)
Total Number of Vacancies
Number of Vacancies (Infant 0-1yr11m)
Number of Vacancies (Preschool Ages 2-5yr11m)
Number of Vacancies School Age (ages 6 yrs and older)
What is your type &/or source of Subsidized Child Care Funding? (check all that apply)
Subsidized

Number of child care slots in your program

Are you willing to accept Child Care Subsidy Payments? If yes, please 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

Toddler Full-Time Cost
Per Week
Toddler Part-Time Cost
Per Week

Preschool

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

School Age

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

Kindergarteners

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

Special Needs

Experience
Education
Specific Needs
Religious Affiliation
Accreditation
Profit
Affiliation

Do you wish to be referred to parents?
Infant License
No file selected
Preschool License
No file selected
School Age License
No file selected
Rate Sheet
No file selected

 

Click on a logo to learn about our amazing partnerships

© 2020 Community Child Care Council of Santa Clara County, Inc

Powered by Firespring