Childcare Helpline Annual Provider Update

Annual Provider Information Update
Thank you for taking the time to update your information with us!! When we have the most up-to-date offerings for a provider, it allows us to better match parents with your services, saving you from unnecessary phone calls. As your availabilities change, send us a quick update here and we will handle the rest. You can also reach us at childcare@helplinecenter.org. Thank you!
Name*

First NameLast Name
Business Name (if applicable):
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Format: (000) 000-0000.
Email*
example@example.com
Type of Care Provided

Full-timePart-timeDrop inTemporaryBefore schoolAfter school24 hours
Days of Operation (check all that apply):*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Hours of Operation (ex. 7:30am to 5:00pm)*
Care for ages blanks months to blank years.
Do you accept Child Care Assistance?*

YesNo
Licensing/Registration*

City Registered Family Day Care Home (up to 12 children)State Registered Family Day Care Home (up to 12 children)State Licensed Group Family Day Care Home (13 to 20 children)Licensed Day Care CentersPreschool ProgramBefore/After School Program
City Registration Number (License ID):
State Registration Number (License ID):
Do you provide transportation?*

YesNo
To which schools do you provide transportation?
Are you on the bus route?

YesNo
To which schools are you on the bus route?
Are you within walking distance to a school (2 blocks or less)?*

YesNo
Which school(s) are within walking distance to you?
Do you have vacancies? (If yes, please list below)*

YesNo
Infant Spots Available
1-3 Year Old Spots Available
3-6 Year Old Spots Available
6 and Older Spots Available
Number of Vacancies
Other information, current updates, rates, etc. that is helpful for parents to know:
Should be Empty:

Annual Provider Information Update