Email Address *
First Name *
Last Name *
Your Address, Please *
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County *
Your HOME Phone Number *
( ) - (###) ### - ####
Your WORK Phone Number
( ) - (###) ### - ####
Your CELL Phone Number
( ) - (###) ### - ####
Please Let Us Know the Best Time to Call You *
Morning: 8am - 12pm Afternoon: 12pm - 5pm Evening: 5pm - 9pm
Curious, How Did You Hear About Us? *
Flyer Postcard Door Hanger Gift Certificate Coffee Shop Direct Mail Friend, Relative, or Neighbor Google Search Craigslist Newspaper Radio TV Sign Promotion Library Other
Please Specify What Other Source
Are You at Least 21 Years of Age? *
When Would You Like to Open Your Doors? *
Immediately 1-3 Months 3-6 Months 6+ Months Undecided
What Kind of Home Do You Have? *
House Condo - Town House Condo - High Rise Apartment Other Daytime Drop-In Care Night Time Drop-In Care Occasional Care - Here & There Undecided Not Applicable
Does Your Home Have a Fenced-In Backyard? *
What Ages Do You Feel Most Comfortable With? *
All 6 Weeks - 12 Months 12 Months - 24 Months 2 - 3 Years Old 3+ Years Old
What is Your Work Availability? *
Full Time Weekdays Only (40-50 Hours) Full Time Weekdays & Weekends (40-50 Hours) Part Time Weekdays Only (20-30 Hours) Part Time Weekdays & Weekends (20-30 Hours) Part Time Weekends Only (15-25 Hours) Other
Is There a Need for Child Care in Your Area? *
Yes, definitely - several I know are waiting! Yes - lots of kids in the area Maybe - I'm not sure No - There are few or no children where I live I have no idea
What Are Your Hopes With This Opportunity? *
What Child Care Experience Do You Have? *
What Degrees/Certifications Do You Hold? *
What's Your Business Experience? *
Do You Have Any of Your Own Children? Ages? *