Top NavigationTop NavigationTop Navigation
Top NavigationHomeProviders

Provider Registration Update Form

Please fill out the following form to UPDATE your program with us.
ALL fields marked RED are required to submit this form
If you are not already registered with us, please use this form to add your information.
If you have trouble filling in this form or need further assistance,
please call us at 580-548-2318, 580-548-2285, 1-800-401-3463 or click here to email us.
If it is a technical (web site) issue you can email the webmaster here
spacer
C
H
I
L
D
C
A
R
E
F
I
N
D
E
R
.
O
R
G

spacer
 Required Information
Today's Date:
First Name:Last Name:
Primary Phone:
Accepted Age Range of Children: (example 1 week to 12 years)
From:
 Youngest
To:
 Oldest
When do you offer Childcare?
Hours of Care:
Days of Week:
Capacity:
Licensed Capacity:
Openings:
Current Openings:
Rate Information:
Age of ChildDaily Full TimeWeekly Full Time
0-12 months
13-23 months
24-35 months
36-47 months
48-60 months
61+ months
Current Star Level:
 One Star   One Star Plus   Two Star   Three Star
Do you accept DHS Subsidy?
 Yes   No
How many children under the age of two will you accept in your center or home?
How many openings for this age group do you have at this time?
 Additional Information
You need only complete this portion if any information has changed since your last update. Thank you.
Street Address:
City:Zip:County:
Secondary Phone:
Fax Number:Email Address:
Website Address:
Business Name:
Major Cross Streets:
1st 2nd
Type of Child Care Program:
 Child Care Center Family Child Care HomeLarge FCC Home
 Pre-School/MDO Drop In CenterSummer Camp
 Before/After School Only Nanny Head Start
 First Start
Do you accept Drop-In care?
 Yes   No
Mailing Address (if different than above):
City:Zip:County:
Contact Name (if different from above):
License Type:
 Center Drop-In Family Child Care Home
 Part Day Exempt 
Funding (check only if you receive this type of funding):
 Head Start State Pre-K Funding
Transportation (check all that apply):
 Transportation Provided Walking Distance to School
 Near Public Transportation Transportation to/from School
 Transportation to/from Home Close to School Bus Stop
 Close to City Bus Stop None
Schools served (if any, list them all):
Accreditation:
 ACSI    COA    NAA    NECPA    NAEYC    NAFCC
Environment: (check all that apply):
 Wheelchair Accessible  No Pet  Smoke Free
Meals: - Does your program participate in the USDA Food Program?
 Yes
 No
Special Needs (check all that apply):
 Behavioral Developmental
 Medical Physical
Education (check as many that apply to you):
 Administrators Credential CDA/CCP Credential
 Associate's Degree - Child Related Associate's Degree - NOT Child Related
 Bachelor's - Child Related Bachelor's - NOT Child Related
 CDA/CCP Currently Enrolled  Certificate of Mastery
 Master's Degree Child Related Master's Degree Not Child Related
Family Care setting?
 House Apartment Townhouse
 Mobile Home Duplex Non-Residential



Thank you for taking the time to complete this form.
Please enter the code shown in the image below and then click the 'Submit' to send us your information.




Back to top



' By Crikey! ' Web Design © Designed & maintained by Paul Deppeler   [ Privacy Statement ]  [ Legal Notice ]  [ Home ]