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Child Care Sign Up Information

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2/11/2020
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Membership Emails

Below is a sample of the emails you can expect to receive when signed up to Child Care.

Raw DataRegistration StructureRegistration Form Text
Registration
Provider Update Please complete this form and check all applicable boxes below. *Asterisk denotes required field Your submission is missing important information and/or contains errors. Please correct the omissions/errors highlighted in red below and resubmit the form.
Business name
Email
Home address
City
State
Zipcode
Provider Update Please complete this form and check all applicable boxes below. *Asterisk denotes required field Your submission is missing important information and/or contains errors. Please correct the omissions/errors highlighted in red below and resubmit the form.
We DO NOT wish to be on your referral list at this time. We will let you know when we wish to be on the referral list again.
Ok to give to parents
Capacity Information:
School Information: (If you do not provide care for School Aged children, skip this section)
How do the children get between school and your program? Please check all that apply
Do you provide transportation to/from the child’s home?
Yes  
No Do you charge a fee for transportation?
Yes  
Does your program teach children a language other than English?*
Yes  
Subsidies: Do you accept the DSHS state subsidy?*
Yes  
No Do you offer a Sliding Scale (fee based on family’s income level)?*
Yes  
No Do you offer a reduction in cost for more than one child in a family?*
Yes  
No Do you offer a scholarship?*
Yes  
Schedule:
No Changes to Schedule Information Our program accepts children:*
Both full and part-time
Full-time only (35 hrs+)
Part-time only Our program operates:*
All year long
During school year ONLY
During summer ONLY Our program opens:* Day Start Time End Time
AM or
AM or
PM
AM or
AM or
PM
AM or
AM or
PM
AM or
AM or
PM
AM or
AM or
PM
AM or
AM or
PM
AM or
AM or
PM If you accept children part time, please specify what type of part time schedule you will accommodate:
Part-Day (4 hours or less per day)        
Part-Week (fewer than 5 days per week) Our program provides/accepts:
Before School care
After School care
Drop-in Care: Provide hourly/daily care on a space available basis.
Temporary/Emergency care: Provide care for more than a week on a space available basis.
Rotating Shift care: Part-time care but not always on the same days. Example: 1st week: M, T, W, Th / 2nd week: F, M, T, W OR 1st week: Monday-Friday / 2nd week: Off
Rates:
No Changes to Rate Information Is your standard fee the same as the DSHS rate?*  
Yes  
Per
Hour
Day
Week
Per
Hour
Day
Week
Per
Hour
Day
Week
Per
Hour
Day
Week
Per
Hour
Day
Week
Per
Hour
Day
Week
Per
Hour
Day
Week
Per
Hour
Day
Week
Per
Hour
Day
Week
Per
Hour
Day
Week
Per
Hour
Day
Week
Per
Hour
Day
Week
Per
Hour
Day
Week
Per
Hour
Day
Week
Per
Hour
Day
Week
Per
Hour
Day
Week
Month Additional Fees: (Check all of the following that apply to your program)
Application/Registration
Supplies
Late child pick-up
Field Trips
Transportation
Enrichment Activities
Require payment in advance
Provider Paid Vacation
Provider Paid Holidays Environment: (Check all of the following that apply to your program)
No Pets
Covered Outdoor Play
Wheelchair Accessible
Non-smoking Premises (At all times)
Eco-Friendly
Nut Free Facility
Uses Woodstove for Heat Special Needs: The Americans with Disabilities Act (ADA) requires all child care providers to make reasonable accommodation to include and support children with special needs. Please answer question 1 to best describe your experience caring for children with special needs and answer questions 2 and 3 as applicable. Question 1: In your program, do you have experience and/or training related to caring for
No experience and/or training, but, have an understanding and interest in working with families to support child/children with special needs as required by the Americans with Disabilities Act
Yes – please see below (question 2 & 3) for any/all specific accommodations available Question 2: If you checked YES for question 1, which of the following thirteen specific accommodations can you provide?
Behavior Supervision/Supports: provide emotional and/or behavior support to children with challenging behaviors
Communication Supports: use sign language, implement speech therapy recommendations, or accommodate assistive communication devices
Diapering/Toileting Assistance: diaper or helping older children with toileting
Eating Assistance: accommodate specific feeding needs or experience with feeding tube
Health Monitoring: care for child with chronic health condition requiring adult support (example: Diabetes or Hemophilia)
Medication Monitoring: ensure child receives required medication and maintain accurate records
Mobility Assistance: modify environment and/or provide assistance to child with wheelchair, crutches, or limited mobility
Nursing Care: access to a nurse for children requiring medical monitoring or intervention
Physical Therapy: accommodate physical/ occupational therapy within program and provide activities to support therapy goals
Respiratory Supports: assist in managing breathing conditions such as asthma; administer inhaler, nebulizer or other prescribed treatments
Sensory Integration: provide supportive activities or other program changes for a child with sensory processing challenges (example: Sensory Processing Disorder)
Specialized Equipment: provide and/or accommodate specialized equipment for child
Vision Supports: provide activities and other program changes to include a child with impaired vision
Question 3: In addition to the specific accommodations you indicated that you can provide, which of the following apply to you and your program?
Experience working with IEP, IFSP and/or 504 plans
Able to work with therapists, teachers and other professionals to meet child's needs, with parent's permission, as required by the American with Disabilities Act Flexibility: Please check the boxes that apply to your program. This is above and beyond what you are listing on your schedule up above.
I am flexible with my opening time : Case by case basis will consider opening earlier than start time
I am flexible with my closing time : Case by case basis will consider closing later than close time
Occasional Evening
Occasional Saturday
Occasional Sunday
Occasional Overnight Field Trips: Does your program take children in your care on field trips? If yes, how are the children and staff transported?
Facility Vehicle
Private Vehicle
Parents Drive
Walking
Public Transportation
No Field Trips Advocacy: Local (city and county) and state policies often affect children, families and child care providers. Your voice makes a difference!
Willing to Participate in Focus Group
Willing to Contact Legislators
Willing to Write Letters
Willing to Visit Legislators
Data Name Data Type Options
Provider Update Please complete this form and check all applicable boxes below. *Asterisk denotes required field Your submission is missing important information and/or contains errors. Please correct the omissions/errors highlighted in red below and resubmit the form.   Text Box
Business name   Text Box
Email   Text Box
Home address   Text Box
City   Text Box
State   Text Box
Zipcode   Text Box
  checklist Provider Update Please complete this form and check all applicable boxes below. *Asterisk denotes required field Your submission is missing important information and/or contains errors. Please correct the omissions/errors highlighted in red below and resubmit the form.
  checklist We DO NOT wish to be on your referral list at this time. We will let you know when we wish to be on the referral list again.
  option
  option Ok to give to parents
  checklist Capacity Information:
  checklist School Information: (If you do not provide care for School Aged children, skip this section)
  checklist How do the children get between school and your program? Please check all that apply
  checklist
  checklist
  checklist
  checklist
  option Do you provide transportation to/from the child’s home?
  option Yes  
  option No Do you charge a fee for transportation?
  option Yes  
  option Does your program teach children a language other than English?*
  option Yes  
  option Subsidies: Do you accept the DSHS state subsidy?*
  option Yes  
  option No Do you offer a Sliding Scale (fee based on family’s income level)?*
  option Yes  
  option No Do you offer a reduction in cost for more than one child in a family?*
  option Yes  
  option No Do you offer a scholarship?*
  option Yes  
  checklist Schedule:
  option No Changes to Schedule Information Our program accepts children:*
  option Both full and part-time
  option Full-time only (35 hrs+)
  option Part-time only Our program operates:*
  option All year long
  option During school year ONLY
  checklist During summer ONLY Our program opens:* Day Start Time End Time
  option
  option AM or
  option
  option AM or
  checklist PM
  option
  option AM or
  option
  option AM or
  checklist PM
  option
  option AM or
  option
  option AM or
  checklist PM
  option
  option AM or
  option
  option AM or
  checklist PM
  option
  option AM or
  option
  option AM or
  checklist PM
  option
  option AM or
  option
  option AM or
  checklist PM
  option
  option AM or
  option
  option AM or
  checklist PM If you accept children part time, please specify what type of part time schedule you will accommodate:
  checklist Part-Day (4 hours or less per day)        
  checklist Part-Week (fewer than 5 days per week) Our program provides/accepts:
  checklist Before School care
  checklist After School care
  checklist Drop-in Care: Provide hourly/daily care on a space available basis.
  checklist Temporary/Emergency care: Provide care for more than a week on a space available basis.
  checklist Rotating Shift care: Part-time care but not always on the same days. Example: 1st week: M, T, W, Th / 2nd week: F, M, T, W OR 1st week: Monday-Friday / 2nd week: Off
  checklist Rates:
  option No Changes to Rate Information Is your standard fee the same as the DSHS rate?*  
  option Yes  
  option Per
  option Hour
  option Day
  option Week
  option Per
  option Hour
  option Day
  option Week
  option Per
  option Hour
  option Day
  option Week
  option Per
  option Hour
  option Day
  option Week
  option Per
  option Hour
  option Day
  option Week
  option Per
  option Hour
  option Day
  option Week
  option Per
  option Hour
  option Day
  option Week
  option Per
  option Hour
  option Day
  option Week
  option Per
  option Hour
  option Day
  option Week
  option Per
  option Hour
  option Day
  option Week
  option Per
  option Hour
  option Day
  option Week
  option Per
  option Hour
  option Day
  option Week
  option Per
  option Hour
  option Day
  option Week
  option Per
  option Hour
  option Day
  option Week
  option Per
  option Hour
  option Day
  option Week
  option Per
  option Hour
  option Day
  option Week
  checklist Month Additional Fees: (Check all of the following that apply to your program)
  checklist Application/Registration
  checklist Supplies
  checklist Late child pick-up
  checklist Field Trips
  checklist Transportation
  checklist Enrichment Activities
  checklist Require payment in advance
  checklist Provider Paid Vacation
  checklist Provider Paid Holidays Environment: (Check all of the following that apply to your program)
  checklist No Pets
  checklist
  checklist
  checklist Covered Outdoor Play
  checklist Wheelchair Accessible
  checklist Non-smoking Premises (At all times)
  checklist Eco-Friendly
  checklist Nut Free Facility
  option Uses Woodstove for Heat Special Needs: The Americans with Disabilities Act (ADA) requires all child care providers to make reasonable accommodation to include and support children with special needs. Please answer question 1 to best describe your experience caring for children with special needs and answer questions 2 and 3 as applicable. Question 1: In your program, do you have experience and/or training related to caring for
  option No experience and/or training, but, have an understanding and interest in working with families to support child/children with special needs as required by the Americans with Disabilities Act
  checklist Yes – please see below (question 2 & 3) for any/all specific accommodations available Question 2: If you checked YES for question 1, which of the following thirteen specific accommodations can you provide?
  checklist Behavior Supervision/Supports: provide emotional and/or behavior support to children with challenging behaviors
  checklist Communication Supports: use sign language, implement speech therapy recommendations, or accommodate assistive communication devices
  checklist Diapering/Toileting Assistance: diaper or helping older children with toileting
  checklist Eating Assistance: accommodate specific feeding needs or experience with feeding tube
  checklist Health Monitoring: care for child with chronic health condition requiring adult support (example: Diabetes or Hemophilia)
  checklist Medication Monitoring: ensure child receives required medication and maintain accurate records
  checklist Mobility Assistance: modify environment and/or provide assistance to child with wheelchair, crutches, or limited mobility
  checklist Nursing Care: access to a nurse for children requiring medical monitoring or intervention
  checklist Physical Therapy: accommodate physical/ occupational therapy within program and provide activities to support therapy goals
  checklist Respiratory Supports: assist in managing breathing conditions such as asthma; administer inhaler, nebulizer or other prescribed treatments
  checklist Sensory Integration: provide supportive activities or other program changes for a child with sensory processing challenges (example: Sensory Processing Disorder)
  checklist Specialized Equipment: provide and/or accommodate specialized equipment for child
  checklist Vision Supports: provide activities and other program changes to include a child with impaired vision
  checklist Question 3: In addition to the specific accommodations you indicated that you can provide, which of the following apply to you and your program?
  checklist Experience working with IEP, IFSP and/or 504 plans
  checklist Able to work with therapists, teachers and other professionals to meet child's needs, with parent's permission, as required by the American with Disabilities Act Flexibility: Please check the boxes that apply to your program. This is above and beyond what you are listing on your schedule up above.
  checklist I am flexible with my opening time : Case by case basis will consider opening earlier than start time
  checklist I am flexible with my closing time : Case by case basis will consider closing later than close time
  checklist Occasional Evening
  checklist Occasional Saturday
  checklist Occasional Sunday
  checklist Occasional Overnight Field Trips: Does your program take children in your care on field trips? If yes, how are the children and staff transported?
  checklist Facility Vehicle
  checklist Private Vehicle
  checklist Parents Drive
  checklist Walking
  checklist Public Transportation
  checklist No Field Trips Advocacy: Local (city and county) and state policies often affect children, families and child care providers. Your voice makes a difference!
  checklist Willing to Participate in Focus Group
  checklist Willing to Contact Legislators
  checklist Willing to Write Letters
  checklist Willing to Visit Legislators

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Comment on: 01/09/2020

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