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Center & Family Whole Record Update
What type of facility are you? (*)
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Name of Business (*)
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Director First Name (*)
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Director Last Name (*)
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Name of Director Designee (*)
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Business Address (*)
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City (*)
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State (*)
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Zip Code (*)
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Phone (*)
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Fax Number
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Website
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Email (*)
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Mailing Address
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General Information

Do you want your program to be on our referral list? (*)
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What is the youngest age of children you will accept? (*)
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What is the oldest age of children you will accept? (*)
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How many caregivers work in your program (not including volunteers, cooks, drivers, housekeepers)? (*)
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Days Care Provided

Do you accept children full time, part time, or both full time and part time? (*)


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Do you offer care 24 hours a day? (*)
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Do you offer after school care for school age children? (*)
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Do you offer care after school (on days children are released early for school age children)? (*)
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Do you offer before school care? (*)
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Do you provide drop in care (accept child for a short period of time on short notice)? (*)
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Do you offer care on graveyard shift (12am - 7am)? (*)
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Do you provide care for a child who is mildly sick? (*)
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Do you provide care on occasion in the evening or overnight? (*)
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Are you willing to offer care on an occasional Saturday? (*)
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Are you willing to offer care on an occasional Sunday? (*)
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Are you open on school holidays that are not State/National Holidays? (*)
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Are you open on State/National Holidays? (*)
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Do you only care for relatives? (*)
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Do you provide care for families that work rotating shifts? (*)
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Do you provide care on Saturdays? (*)
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Do you provide sick care? (*)
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Do you provide care on Sundays? (*)
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Do you provide care for families that work swing shifts (4pm - 12 am)? (*)
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Do you provide care in a temporary situation or in an emergency? (*)
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Days and Hours

Monday Open
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Monday Close
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Tuesday Open
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Tuesday Close
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Wednesday Open
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Wednesday Close
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Thursday Open
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Thursday Close
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Friday Open
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Friday Close
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Saturday Open
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Saturday Close
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Sunday Open
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Sunday Close
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Capacity

0-11 Months

Licensed Capacity
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Full Time Vacancies
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Number of Rooms (*)
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Classroom name(s) (*)
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12-23 months

Licensed Capacity
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Full Time Vacancies
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Number of Rooms (*)
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Classroom name(s) (*)
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2 years

Licensed Capacity
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Full Time Vacancies
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Number of Rooms (*)
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Classroom name(s) (*)
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3 years

Licensed Capacity
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Full Time Vacancies
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Number of Rooms (*)
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Classroom name(s) (*)
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4 to 5 years

Licensed Capacity
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Full Time Vacancies
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Number of Rooms (*)
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Classroom name(s) (*)
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Kindergarten

Licensed Capacity
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Full Time Vacancies
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Number of Rooms (*)
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Classroom name(s) (*)
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School-Age

Licensed Capacity
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Full Time Vacancies
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Number of Rooms (*)
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Classroom name(s) (*)
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Total Number of Full Time Vacancies

Total number of vacancies for children 23 months and younger (*)
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Total number of vacancies for children 2 years old and older (*)
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Facility Information

Number of diapering stations? (*)
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Number of restrooms? (*)
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Do you have restrooms in all 2 years old and older classes? (*)
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Number of playgrounds? (*)
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Names of playground(s) and ages that use them: (*)
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Do you have a Activity/Gym area? (*)
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Enrollment and Rates

0-11 Months

Current Number of Children Enrolled
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Monthly Rate (*)
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12-23 months

Current Number of Children Enrolled
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Monthly Rate (*)
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2 years

Current Number of Children Enrolled
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Monthly Rate (*)
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3 years

Current Number of Children Enrolled
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Monthly Rate (*)
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4 years

Current Number of Children Enrolled
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Monthly Rate (*)
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5 years (Pre-K)

Current Number of Children Enrolled
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Monthly Rate (*)
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Kindergarten - in school

Current Number of Children Enrolled
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Monthly Rate (*)
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Kindergarten - out of school

Monthly Rate (*)
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School Age - in school

Current Number of Children Enrolled
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Monthly Rate (*)
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School Age - Out of School

Monthly Rate (*)
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Special Needs

Do you have experience, training, or are willing to be trained with any of the following special needs?





















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If you marked "other," please list:
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Elementary Schools Served (please list any schools, both public and private that you service):
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Languages

Please mark all the languages spoken in your program:











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If you marked "other," please list:
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Environment

Do you accept state child care subsidy? (*)
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There is Public Transportation (UTA) near my facility. (*)
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I have pets that interact with the children in my program. (*)
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I never allow smoking on the premises including after hours. (*)
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I offer an educational preschool program for 3-5 year olds. (*)
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National Accreditation

Please mark the organization by which your program is nationally accredited:


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Other Information

Please use this space to provide other information about your program which you would like us to know or share with parents.
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Would you like this information to show on your Care About Childcare Marketing Page?
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Would you like one of our staff members to contact you and help you get started on your Marketing Page and Quality Indicators to showcase the quality in your program?
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If you need to update other information or have questions about this form, please contact our office at 801-355-4847 or 866-438-4847 - Monday through Thursday 7:30 AM - 6:00 PM(MST)

Funding for Children’s Service Society is provided by the following organizations and agencies

Ally Bank
American Express
Castle Foundation
The Church of Jesus Christ of Latter-day Saints Foundation
Daniels Fund
Department of Workforce Services – Office of Child Care
eBay Give
Edwards Lifesciences Fund
Energy Solutions
Frances W. Burton Foundation
George & Dolores Doré Eccles Foundation
Henry W. and Leslie M. Eskuche Foundation
Herbert I. and Elsa B. Michael Foundation
In-N-Out Burger Foundation

Intermountain Healthcare Community Partner Fund
John & Dora Lang Foundation
Kennecott Utah Copper Charitable Foundation
Larry H. Miller Charities
Lawrence T. Dee & Janet T. Dee Foundation
Marriner S. Eccles Foundation
R. Harold Burton Foundation
Ruth Eleanor & John Ernest Bamberger Memorial Foundation
Salt Lake County Substance Abuse Prevention Services
Sorenson Legacy Foundation
Sterling & Shelli Gardner Foundation
United Way of Salt Lake
UPS Foundation
Utah Division of Child & Family Services
Utah Health Department, Office of Home Visiting
Utah Masonic Foundation