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This Provider Update Form is available to all registered/licensed child care providers. Please use it in order to keep our records updated. This information will assist us in providing referrals to families requesting child care. Complete all of the information on this form and submit it as soon as possible. Please use it whenever there is a change or vacancy in your program. If you have any questions, please contact Alice Rosado, 845-425-0009 x487 or alicer@rocklandchildcare.org

Status
Show House Number?
Referral Status
CARES Provider
CARES 3 Provider
Number of vacancies for infants
Number of vacancies for toddlers
Number of vacancies for preschool age children
Number of vacancies for school age children
Transportation
Programs
Check all that apply
Environment
Please check all that apply
Meals
Check all that apply
Do you participate in the CACFP food program?
Financial Assistance
Check all that apply
Do you have special needs experience?
Types of Experience
Check all that apply
NYS MAT Approved
Affiliation
Hours
Duration

Hours

Start Time/End Time; ex. 9am-5pm
Start Time/End Time; ex. 9am-5pm
Start Time/End Time; ex. 9am-5pm
Start Time/End Time; ex. 9am-5pm
Start Time/End Time; ex. 9am-5pm
Start Time/End Time; ex. 9am-5pm
Start Time/End Time; ex. 9am-5pm
Schedule
Check all that apply

Fee Schedule

Rate per hour or week
Rate per hour or week
Rate per hour or week
Rate per hour or week
Rate per hour or week
Rate per hour or week
Special Fees