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Day Care Center Profile

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									                  Child Care Council of Orange County, Inc.
                          Day Care Center Profile

Business Name                 Directors: First Name                Last Name

Address (Location)

City                                    State                      ZIP

Address (Mailing)

City                                    State                      ZIP

Phone #:________________________________________________________________
Additional Contact #:_____________________________________________________
Fax#:___________________________________________________________________
E-Mail Address: _________________________________________________________
Website: _______________________________________________________________
Hours of Operation: ______________________________________________________
Total Capacity: ___________________________ Vacancy: ______________________

SERVICES OFFERED: (Please check all that pertain)
Check               Full Time Cost              Part Time Cost     Openings
___Infant           ____________                _____________      ________
___Toddler          ____________                _____________      ________
___Preschool        ____________                _____________      ________
___School Age       ____________                _____________      ________
___Kindergarten     ____________                _____________      ________
___Nursery          ____________                _____________      ________
___Special Education ___________                _____________      ________
___Head Start       ____________                _____________      ________
___Early Head Start ____________                _____________      ________
___Pre-K            ____________                _____________      ________

SCHEDULE: (Check all that apply)
         Days of Operation:
Sunday          Monday        Tuesday           Wednesday   Thursday     Friday Saturday
         Hours of Operation
From:                             To:
Do you have extended hours: _________ If so, from:          to:



REGUALTION INFORMATION:
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       Registration/License#:_______________________________________________
       Expiration Date: ____________________________________________________
       Registration/License Capacity: ________________________________________
       Do you regularly enroll fewer children than your registration/licensed capacity?
                YES                            NO
       If so, please list preferred capacity: _____________________________________
       Ages served: From: ______________________ to: ________________________
       Day Care setting: (circle one) Non-residential Faith Based Work Place School

ENVIRONMENT: (Check all that apply)                      CARE IS AVAILABLE:
___Non Smoking                                       ___Full Time (5 days a week)
____No Pets (Inside or outside)                      ___Part Time (less than 5 days)
____Pool
___Computer
___Outdoor Play Area
___Fireplace
___Wood Stove
___Other – please list______________________________________________________


MEALS SERVED                               DAY SCHEDULE
___Breakfast                               ___Standard day (approx. 9-3)
____AM Snack                               ___Early Day
____Lunch                                  ___Late Day (Afternoon Hours)
____PM Snack                               ___Flexible
____Dinner                                 ___Evening Hours (after 6pm)
____CACFP Food Program                     ___Overnight
____Parents Provide                        ___Rotating          ___24Hrs.

YEAR SCHEDULE                              SCHOOL SCHEDULE
___School Year (Sept.-June)                ___Before School
___Summer (June-Sept.)                     ___After School
                                           ___Before Kindergarten
                                           ___After Kindergarten

SPECIAL SCHEDULE                           PROGRAM
__Drop In (Short Notice)                   __ Academic           __Montessori
__Temporary (Short term/emerg)             __ Preschool          __Developmental
__Sick Care (Mildly Ill)                   __ High Scope         __Religious
__Snow Days                                __ Pre-kindergarten


LIST ALL LANGUAGES SPOKEN IN YOUR CARE
FACILITY/PROGRAM:
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_____________________________________________________________
________________________________________

PLEASE LIST ANY SCHEDULING RESTRICTIONS: (I.E. NO
PART TIME INFANTS, ETC.)__________________________________
_____________________________________________________________

AFFILIATION: (Business status of the facility)
___College Operated                                 ___ Employer Affiliation
___Employer Managed                                 ___ Independent Proprietary
___Proprietary Franchise                            ___ Non-Profit
___ Religious
___Public School (Operated by a School District)
___GOER Site (Governors Office of Employer Relations)
ACCREDIDATION: (Please check all that apply to care facility/program and list
date of renewal)
___ National Association of the Education of Young Children (NAEYC) _____________
___ National Association of Family Child Care (NAFCC) _________________________
___ National School Age Child Care Association (NSACCA) ______________________
SCHOOLS SERVED: (Please list all Elementary and Middle Schools which will
transport to and from you care facility/program) _________________________________
________________________________________________________________________

PROVIDER STATEMENT: (Use this space to describe additional features of the
care facility/program) ______________________________________________________


SPECIAL NEEDS:
The Facility/Program is able to accommodate the following needs (check all that apply)
___Wheel Chair Access
___Special Medical, Nutritional or Physical Care Needs Attended to (i.e. apnea monitor,
food allergy, etc.)
___Special Diet (offers requests for nutritional and religious needs)
___Moderately Ill/Health Services (can offer care to a child whose health status requires
specialized services and monitoring of a health professional)
___Inclusive Program (program specifically incorporates children with special needs)
___Care Facility/Program currently had child with Developmental or Education
Disability enrolled
___Bilingual                                  ___Sign Language
___Other- please list ______________________________________________________

TRAINING:

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Center Directors have the option to share information about Facility/Program Staff on
Certifications/Credentials/Degrees received by individuals:
Check all that apply and list dates          Received               Renewal Date
___Child Development Associate (CDA) _______                        ____________
___ Infant Toddler CDA                       _______                ____________
___School Age CDA                            _______                ____________
___NYS Children’s Program Administration _______                    ____________
___NYS Certified N-6
___Associates In Early Childhood Education
___Bachelors in Early Childhood Education
___Special Education Degree
___CPR Certified Expiration Date________ First Aid Certified Expiration Date _________
Additional Training Comments: _____________________________________________




STAFF INFORMATION:
________________________________________________________________________
Title     Degree               Starting Salary                    Present Salary
Benefits: (please circle all that apply) Health Benefits      Paid Holidays
Paid Sick Days         Paid Vacation         Education Reimbursement
Child Care-Full        Child Care-Discount          Child Care- Free
Annual Salary Review
________________________________________________________________________
Title     Degree               Starting Salary                    Present Salary
Benefits: (please circle all that apply) Health Benefits      Paid Holidays
Paid Sick Days         Paid Vacation         Education Reimbursement
Child Care-Full        Child Care-Discount          Child Care- Free
Annual Salary Review
_______________________________________________________________________
Title     Degree               Starting Salary                    Present Salary
Benefits: (please circle all that apply) Health Benefits      Paid Holidays
Paid Sick Days         Paid Vacation         Education Reimbursement
Child Care-Full        Child Care-Discount          Child Care- Free
Annual Salary Review
______________________________________________________________________
Title     Degree               Starting Salary                    Present Salary
Benefits: (please circle all that apply) Health Benefits      Paid Holidays
Paid Sick Days         Paid Vacation         Education Reimbursement
Child Care-Full        Child Care-Discount          Child Care- Free
Annual Salary Review


___________________________________________________________________
Title   Degree          Starting Salary               Present Salary

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Benefits: (please circle all that apply) Health Benefits      Paid Holidays
Paid Sick Days         Paid Vacation         Education Reimbursement
Child Care-Full        Child Care-Discount          Child Care- Free
Annual Salary Review
_______________________________________________________________________
Title     Degree               Starting Salary                    Present Salary
Benefits: (please circle all that apply) Health Benefits      Paid Holidays
Paid Sick Days         Paid Vacation         Education Reimbursement
Child Care-Full        Child Care-Discount          Child Care- Free
Annual Salary Review
________________________________________________________________________
Title     Degree               Starting Salary                    Present Salary
Benefits: (please circle all that apply) Health Benefits      Paid Holidays
Paid Sick Days         Paid Vacation         Education Reimbursement
Child Care-Full        Child Care-Discount          Child Care- Free
Annual Salary Review


TRANSPORTATION
___Near Public Transportation                       ____Provides Transportation
____Located on School Bus Route                     ____Transports to Bus Stop

Please list cross streets and landmarks which will make the care facility/program easy for
parents to find: ___________________________________________________________
_______________________________________________________________________

Subsidy & Discounts: (Check all that apply)
___County Contract (existing LDSS Contract)          ____Voucher
___Employer Discount                                 ___United Way Scholarship Fund
___Scholarship (with affiliated education institution, i.e. SUNY)


MISCELLANEOUS
Additional comments or statements: _________________________________________
________________________________________________________________________
________________________________________________________________________




Census Bureau Questions (Optional)
# Of Staff who are Spanish/Hispanic/Latino:
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_____Mexican      ____ Puerto Rican         _____Cuban
_____Mexican American   ____ other: ___________________________

# of staff that’s race is:
____ White                 ____ African American      _____American Indian
____ Native Hawaiian____ Filipino              _____ Japanese
____ Chinese               ____ Indian (India)
____ Other: _____________________________________________________________

# Of Staff who speak another language beside English? _______________________
What? _________________________________________________________________
_______________________________________________________________________




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