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Provider Full Update Form

Are you a licensed or registered Child Care Program in
Dutchess or Putnam County, NY?

We would like to gather some information to be able to refer your program to families that call us in need of child care.
We are required by The Early Care and Learning Council to do a full update on all child care providers annually.
It may be more convenient for you to fill out an online form than to receive a 15 - 20 minute phone call from our referral service. 
Please fill out all fields in the form below and hit the "SUBMIT" button.
If you have any questions, or need to update any additional information, please give us a call! (845) 473-4141.


Provider FULL Update

Contact Information

If you have more than one location/site, please fill out an update form for each location/site.

Please be sure that all of the information you provide has been approved by your registrar or licensor.

First Name
Last Name
If different than Director/Provider
For parents to use.
First Name
Last Name
For Council updates (if different than above).
First Name
Last Name

Address

What county is your program located in

Phone Number

For parents to use.
Phone Number
ext Extension
For Council updates (if different than above)
Phone Number
ext Extension

Email Address

Website


Program Information

(This may be the same as your Licensed Capacity, but cannot be higher.)

Ages of children you are willing to provide care for:


Days and Hours of Operation

What days of the week do you operate?
Check all that have been approved by your registrar or licensor.

What are your approved hours of operation?

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Rates and Vacancies

If you have a rate sheet and would prefer to email or fax that information to us, you can do so at:
Email: services@childcaredutchess.org
Fax: (845) 473-8031

You only need to fill out the rates and vacancies for your modality.

Day Care Center

Vacancies for 6 weeks - 18 months.
Rates for 6 weeks - 18 months
Enter "zero" if you don't accept this age group. Please specify weekly, daily and/or hourly rates.
Vacancies for 19 months - 35 months
Rates for 19 months - 35 months
Enter "zero" if you don't accept this age group. Please specify weekly, daily and/or hourly rates.
Vacancies for 3 - 4 Years
Rates for 3 - 4 Years
Enter "zero" if you don't accept this age group. Please specify weekly, daily and/or hourly rates.
Vacancies for 4 - 5 years
Rates for 4 - 5 years
Enter "zero" if you don't accept this age group. Please specify weekly, daily and/or hourly rates.
Vacancies for 5 - 10 years
Rates for 5 - 10 years
Enter "zero" if you don't accept this age group. Please specify weekly, daily and/or hourly rates.
Vacancies for 10 - 12 years
Rates for 10 - 12 years
Enter "zero" if you don't accept this age group. Please specify weekly, daily and/or hourly rates.

Family Day Care/Group Family Day Care

Vacancies for 6 weeks - 2 years
Rates for 6 weeks - 2 years
Enter "zero" if you don't accept this age group. Please specify weekly, daily and/or hourly rates.
Vacancies for 2 - 5 years
Rates for 2 - 5 years
Enter "zero" if you don't accept this age group. Please specify weekly, daily and/or hourly rates.
Vacancies for 5 - 12 years
Rates for 5 - 12 years
Enter "zero" if you don't accept this age group. Please specify weekly, daily and/or hourly rates.

School Age Child Care

Vacancies for 5 - 10 years
Rates for 5 - 10 years
Enter "zero" if you don't accept this age group. Please specify weekly, daily and/or hourly rates.
Vacancies for 10 - 12 years
Rates for 10 - 12 years
Enter "zero" if you don't accept this age group. Please specify weekly, daily and/or hourly rates.

Printed Rates
It is important for us to collect rates for statistical purposes, such as determining the average cost of care. If you would prefer for your rates not to be printed on profiles given to parents, please let us know.

Do you have any Additional Fees:
Check all that have been approved by your registrar or licensor

Financial Assistance Opportunities
Check all that have been approved by your registrar or licensor.
Click HERE for a definition of each of these terms.

School District


Transportation Opportunities:

Languages spoken by the caregivers in your program:

Are you NYS Approved to give medication?
If you are interested in becoming MAT Approved, contact Megan Weber at (845) 473-4141 x231.

Enter the category that best describes the type of program conducted or operated at your facility.
Check all that have been approved by your registrar or licensor.
Click HERE for a definition of each of these terms.

This program accepts children:

This program operates:

Extra Care Services
Check all that have been approved by your registrar or licensor.
Click HERE for a definition of each of these terms.

Endorsements:
Check all that have been approved by your registrar or licensor.
Click HERE for a definition of each of these terms.

Environment
Check all that have been approved by your registrar or licensor.
Click HERE for a definition of each of these terms.

Meals Offered
Check all that have been approved by your registrar or licensor..
If you are interested in The Child and Adult Care Food Program (CACFP),
contact Lorraine Scuccimarra at (845) 473-4141 x220 for FDC and GFDC or
CACFP at the Department of Health in Albany (800) 942-3858 for DCC and SACC.
Special Diet
Check all that have been approved by your registrar or licensor.
Click HERE for a definition of each of these terms.
These are general guidelines only; please discuss any specific details with parents.

Special Needs Education/Experience
Do you have any education or experience in the following areas?
Check all that have been approved by your registrar or licensor.
Click HERE for a definition of each of these terms.

Additional Care Services offered
Check all that have been approved by your registrar or licensor.
Click HERE for a definition of each of these terms.

Do you (or any of your staff) have a Child Development Associate?
Check all that have been approved by your registrar or licensor.

Policies Available
Check all that have been approved by your registrar or licensor.

Census Data

The following fields are optional and will be used for statistical purposes only.

Number of Persons on staff who are Spanish/Hispanic/Latino:


Number of persons on staff whose race is:


Number of persons on staff who speak a language other than English:

Additional Details
Please use this space to provide us with any additional information, questions or comments.

Thank you for your time!

Don't forget to click the SUBMIT button below.