CHILDCARE PROVIDERS

GARLAND & RICHARDSON CHILDCARE ASSOCIATION

MEMBERSHIP APPLICATION

NAME: ________________________________________________________________

ADDRESS: _____________________________________________________________

CITY: _________________________________________________ ZIP:_____________

PHONE: ____________________________________

BIRTH DATE: _______________

E-MAIL ADDRESS ________________________________________________________

WHAT IS YOUR NEAREST MAJOR INTERSECTIONS? __________________________________________________________________________

WHAT AGES OF CHILDREN DO YOU PREFER: INFANTS_____ TODDLERS______

SCHOOL AGE_________ WILL YOU DO BACK-UP OR DROP-IN CARE? __________

WILL YOU PROVIDE NIGHT CARE? __________WEEKEND CARE? ___________

WILL YOU BE TRANSPORTING CHILDREN? _____________________________

WHAT IS YOUR NEAREST ELEMENTARY SCHOOL? ____________________________

STATE REGISTRATION# ________________ CITY OF RICHARDSON# _________

A COPY OF YOUR CURRENT CHECK SENT TO T.D.P.R.S. FOR LISTING OR REGISTRATION, (OR IN PROCESS) IN ORDER TO RECEIVE REFERRAL.

PLEASE CHECK AREAS OF TRAINING YOU ARE MOST INTERESTED IN:

INFANT AND CHILDHOOD DEVELOPMENT ________

HEALTH AND SAFETY_________ DAYCARE TAXES _______________________

PROFESSIONALISM ___________ CULTURAL, INDIVIDUAL DIVERSITY ______

HEALTH AND SAFETY _____________ MARKETING YOUR BUSINESS ________

I AGREE TO SUPPORT AND UPHOLD THE BYLAWS OF THE CHILDCARE PROVIDERS GARLAND & RICHARDSON CHILDCARE ASSOCIATION.

SIGNATURE: __________________________________ DATE: __________________

 

For FREE Childcare referrals call (972) 496-4600