After School Military SICK CHILD CARE Child Care Center Playgroup Summer Camp Early Head Start PRIVATE SCHOOL TEEN PARENT Family Child Care Home PUBLIC SCHOOL VPK School Year Head Start Quality Rating System VPK Summer Large FCCH School Age Program Migrant Head School Readiness PrOVIDER 8. In the table below enter the advertised rates (private pay rates) your program charges. Do not include voucher/subsidy rates, sliding scale rates, employee discounts or any other discounted rates. Only complete the rate type for each age group that you offer. (Please attach rate sheet, if applicable). Elem Mid Enter Rate by Age Group. 1 year 2 year 3 year 4 year 5 year Infant School School Check frequency for each option below. old old old old old Age Age FULL TIME Weekly Monthly Annually FULL TIME VPK WRAP Weekly Monthly Annually PART TIME Weekly Monthly Annually PART TIME VPK WRAP Weekly Monthly Annually SCHOOL AGE BEFORE SCHOOL Weekly Monthly Annually SCHOOL AGE AFTER SCHOOL Weekly Monthly Annually SCHOOL AGE BOTH BEFORE & AFTER – SCHOOL Weekly Monthly Annually SUMMER CAMP Weekly Monthly Annually 9. SCHEDULE - What days of the week does your program operate? all that apply) Sunday Monday Tuesday Wednesday Thursday Friday Saturday Hours of Operation: Open: Close: AM PM AM PM Ages of Children Served: Minimum: (Months/Years) (Months/Years) Does your program provide the following schedule? 10. PROVIDER (ENHANCED) SCHEDULE - all that apply) 24-Hour Care Full Time School Syst Weather Days After School Full Year School Year Before School Overnight SHIFT Drop In Care Part Time Weekend Emergency/Temporary Care Respite Care Evening Care Summer Only
After School Military SICK CHILD CARE Child Care Center Playgroup Summer Camp Early Head Start PRIVATE SCHOOL TEEN PARENT Family Child Care Home PUBLIC SCHOOL VPK School Year Head Start Quality Rating System VPK Summer Large FCCH School Age Program Migrant Head School Readiness PrOVIDER 8. In the table below enter the advertised rates (private pay rates) your program charges. Do not include voucher/subsidy rates, sliding scale rates, employee discounts or any other discounted rates. Only complete the rate type for each age group that you offer. (Please attach rate sheet, if applicable). Enter Rate by Age Group. Check frequency for each option below. Infant 1 year old 2 year old 3 year old 4 year old 5 year old Elem School Age Mid School Age FULL TIME Weekly Monthly Annually FULL TIME VPK WRAP Weekly Monthly Annually PART TIME Weekly Monthly Annually PART TIME VPK WRAP Weekly Monthly Annually SCHOOL AGE BEFORE SCHOOL Weekly Monthly Annually SCHOOL AGE AFTER SCHOOL Weekly Monthly Annually SCHOOL AGE – BOTH BEFORE & AFTER SCHOOL Weekly Monthly Annually SUMMER CAMP Weekly Monthly Annually 9. SCHEDULE - What days of the week does your program operate? all that apply) Sunday Monday Tuesday Wednesday Thursday Friday Saturday Hours of Operation: Open: AM PM Close: AM PM Ages of Children Served: Minimum: (Months/Years) (Months/Years) 10. PROVIDER (ENHANCED) SCHEDULE - Does your program provide the following schedule? all that apply) 24-Hour Care Full Time School Syst Weather Days After School Full Year School Year Before School Overnight SHIFT Drop In Care Part Time Weekend Emergency/Temporary Care Respite Care Evening Care Summer Only
CCRR_Provider_Update_Form_ELC_address_2014-15ELC.docx