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To apply for Membership to the CHILDCARE4U Association, please complete this form.
Daycare Owners First & Last Name:
Daycare Home Address
Contact Phone Number:
Contact Email
Daycare Hours of Operation:
If you run this daycare with another individual, please list there name here:
How did you hear about the CHILDCARE4U Association?
From a friend or neighbor
From a daycare acquaintance
Childcare Answers
From a current or past member
Other
If you were referred by a current/past CHILDCARE4U MEMBER, please list their name:
Are you a state licensed daycare provider?
If you answered YES to the above question, please enter your LICENSE number:
Why do you want to join the CHILDCARE4U?
How many children are currently enrolled in your program?
1-5
5-10
10+
Do you employ staff members at your daycare home?
Have you updated your CPR/FIRST AID certifications within the last year?
Are you on the PTQ program?
Do you accept CCDF vouchers for childcare program?
Are you part of the CACFP?
If yes, who is your sponsor?
Have you ever owned a childcare home that was shut-down by the state?
Yes
No
If you answered yes, please explain.
Please check the boxes below to indicate your understanding of the following CHILDCARE4U terms and conditions:
Meeting & Open houses are held at member's homes.
You must volunteer to host a Meeting at some point
Attendance required 1 time every 3 months, minimum
We are NOT a licensing/inspecting agency
Please take a moment to tell us about yourself and your daycare:


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