Exempt Emergency Child Care Inquiry Form for Programs
Please complete this form if you are interested in operating an Exempt Emergency Child Care Program during the COVID-19 State of Emergency. Once you submit this form, you will be contacted by a Department of Early Education and Care staff member for more information.
Email address *
What is the full name of your primary contact person? *
Your answer
What is the phone number of your primary contact person? (XXX-XXX-XXXX) *
Your answer
What is the email address of your primary contact person? *
Your answer
Who is the lead agency/organization that will be responsible for operational and fiscal oversight of the site? *
Each site must designate a lead agency or organization that will be responsible for the administration of the site. In the event that multiple child care organizations are combining efforts to support one site, please only list one organization as the lead agency. If you are a family child care provider looking to open an Exempt Emergency Child Care Site in your home, please list your name here.
Your answer
If you plan to partner with another agency/organization to operate a site, please list the partner agencies (if known at this time)
Your answer
What is the location (street address) of the proposed Exempt Emergency Child Care Site? *
Please provide the street address of the location where the Exempt Emergency Child Care Site would be opened.
Your answer
Street Address #2:
Your answer
City: *
ZIP Code *
Your answer
Please list the EEC region that your proposed site is located, if known *
Is this proposed site currently licensed by EEC to serve child care children? *
Please indicate whether this proposed site is currently licensed by the Department of Early Education and Care.
If the site is currently licensed by EEC, please list the Program ID.
If this site is currently licensed by EEC, please list the Program ID number (if known)
Your answer
If the site is currently licensed by EEC, has your site ever served subsidized children?
What days would the proposed Exempt Emergency Child Care Site operate? *
Required
What hours would the proposed Exempt Emergency Child Care Site open on weekdays? *
Time
:
What hours would the proposed Exempt Emergency Child Care Site close on weekdays? *
Time
:
What hours would the proposed Exempt Emergency Child Care Site open on weekends, if applicable?
Time
:
What hours would the proposed Exempt Emergency Child Care Site close on weekends, if applicable?
Time
:
What is the total number of children that the proposed Exempt Emergency Child Care Site will serve? *
Please input the number of children that this program can anticipate serving at one time.
Your answer
If currently licensed by EEC, what is current licensure capacity?
Please input the number of children that this program is currently licensed to serve.
Your answer
Any additional information regarding your site's expected capacity at this time?
Your answer
What are the age groups that the proposed Exempt Emergency Child Care Site will serve? *
Please check any and all age groups that the Temporary Emergency Child Care Site intends to serve.
Required
If this proposed site is currently licensed by EEC, what age groups does the site currently serve?
Please check any and all age groups that the proposed site currently serves.
Any additional information regarding your site's expected age groups at this time?
Your answer
Have all of your staff undergone a background check? *
If you answered "No" to the question above, please provide detail about how many of your staff have not undergone a background check and what their job titles are.
Your answer
Once operational, would you agree to having your site advertised so that parents can contact you for enrollment information? *
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