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Child Care Center Fact Sheet

Please complete a separate fact sheet for each program.

If you would rather print out the fact sheet and mail it in, click here to download the PDF version.

Please select the office to which you want to send this form:

1. Billing name:
2. Billing Address:
City, state, zip:    
3. Billing phone:
4. Center name:
5. Address:
City, state, zip:    
6. Phone:
7a. Web-site address: http://
7b. Email:
8. Type of center: Preschool   Infant   Toddler  
Other (please describe below):  
9. Is your organization: For-profit   Not-for-profit
10. Description of center:
11. Age range of children / students:
12. Total number of students in center:
13. Average number of children per classroom:
14. Student / Teacher Ratio:
15.

Any children with special needs? Yes   No
If yes, please explain:
16. Teaching philisophy:
17. Brief job description (job description/competency requirements):
18. Special attributes or skills required:
19. Essential skills required CPR   First Aid   OCCS Teacher Qualified  
OCCS Teacher Certified
20a. Length of ARBOR employee break:
20b. Is break paid or unpaid by center? Paid   Unpaid
21. List your authorized contact staff who will be requesting ARBOR's services:
Name:   Title:
Name:   Title:
Name:   Title:
22.

Complete the transportation directions in as much detail as possible by car and public transportation, if applicable. The directions you give are the directions we will give our staff to get to your program. Please give an approximation of miles, landmarks, colors of the building or house, major highways and bus numbers. Please use additional paper if necessary.

Directions by Car: (ALSO, please include landmarks, building description and entrance procedures. Example: "Center is located in a brick building next to a Starbucks Coffee—ARBOR Staff must sign-in at front desk."

Is parking available? Yes   No  
Where?

Directions by MBTA (bus and/or subway):
23. Is an orientation manual on the site for our staff? Yes   No
Where?
24.

What are the procedures in an emergency situation?
25. Who do we call?
Phone:  
Pager:
26.

Where are the emergency procedures located on site?
27. Fact Sheet completed by: Name:  
Title: