Fillable Child Care Center Business Form (Childcare Aware MN)

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Child Care Center Business Form (Childcare Aware MN)

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SECTION A: CONTACT INFORMATION
Business Name ______________________________________________________________ Date Completed ____________________
License #___________________ County ___________________________ Phone Number ______________________________
Mailing Address__________________________________________ City _____________________________ Zip___________
Email Address (for Child Care Aware to connect with you) ____________________________________________________
Email Address (for parents looking for child care) ______________________________________
Preferred Business Name ___________________________________
Are you currently providing child care? YES NO
If no, are you planning on returning to child care? Not planning to return Yes. Date of expected return? ______________
During this public health emergency, complete the questions below based on how you would typically operate your child care program. Because the
participation of every licensed childcare provider is so important, Child Care Aware of Minnesota staff will contact you regarding the update until you
complete and return the questionnaire or indicate that you do not wish to participate. To indicate that you do not wish to participate, please
complete the contact information above and check the box marked “I decline to participate in the Provider Business Update,” and return the first
page to us. You may also call 888-291-9811 or email InformationServices@ParentAware.org
and indicate that you do not wish to complete the update.
If you reach voicemail, please leave your name and phone number so that the Child Care Aware staff can identify your program.
I decline to participate in the Provider Business Update
Please return the Provider Business Update to:
Child Care Aware of Minnesota
Attn: Parent Service Specialists
10 River Park Plaza
Suite 820
Saint Paul, MN 55107
SECTION B: ENROLLMENT INFORMATION
1. What ages are you willing to care for?
Example: 6 weeks to 12 years
___________________ to _________________
2. How many children are currently enrolled in your child
care program (include full and part-time)?
Infants
Toddlers
Preschoolers
School-Age
3. How many children do you want enrolled in your child care
program at one time (desired enrollment)?
Infants
Toddlers
Preschoolers
School-Age
4. What is your total desired enrollment? ________
Minnesota Child Care Provider Business Update for Child Care Centers 2
SECTION C: RATES & FEES
For each question below, if your program charges different rates, please enter the HIGHEST rate. For example, if your program charges a
higher rate for school-age care during the summer than you charge for school-age care during the school year, enter the summer rate.
1. HOURLY RATES: Does your program charge hourly rates?
YES NO DECLINE TO ANSWER
If YES, please list highest hourly rates below
Infants
Toddler
Preschooler
KG-School-Age
$ $ $ $
No rate for
this age group
No rate for
this age group
No rate for
this age group
No rate for
this age group
2. DAILY RATES: Does your program charge daily rates?
YES NO DECLINE TO ANSWER
If YES, please list highest daily rates below
Infants
Toddler
Preschooler
KG-School-Age
$ $ $ $
No rate for
this age group
No rate for
this age group
No rate for
this age group
No rate for
this age group
3. WEEKLY RATES: Does your program charge weekly rates?
YES NO DECLINE TO ANSWER
If YES, please list highest weekly rates below
Infants
Toddler
Preschooler
KG-School-Age
$ $ $ $
No rate for
this age group
No rate for
this age group
No rate for
this age group
No rate for
this age group
4. Does your program charge any rate besides hourly, daily,
or weekly (such as before/after school, monthly, etc.)?
YES NO DECLINE TO ANSWER
5. Does your program have a deposit requirement?
(refundable)
YES NO DECLINE TO ANSWER
If Yes, HIGHEST amount charged $________________
6. Does your program have a registration fee? (non-
refundable)
YES NO DECLINE TO ANSWER
If Yes, HIGHEST amount charged $ _________________
7. Can we share your rates with parents looking for care
through our phone and online referral services?
YES NO
8. Are you currently caring for children on child care
assistance (CCAP) or subsidy?
YES, currently caring for CCAP children
NO, not currently caring for CCAP children but willing to
NO, and not willing to care for CCAP children
9. If yes, and the rate reimbursed by CCAP is not your full
private pay rate, do you charge families the difference in
addition to collecting their copay?
YES NO
10. What are the barriers your program faces in caring for
children on child care subsidy? (Check all that apply)
Payment rates are too low
There is too much paperwork to get approved
I need to get paid before caring for children
Payment rules are too complicated
Billing form is hard to use
Electronic billing is hard to use
My county does not offer an electronic billing option
It takes too long to get paid
Not enough absent days are paid
Too hard to reach a family’s worker when I have
questions
Minnesota Child Care Provider Business Update for Child Care Centers 3
SECTION D: BUSINESS PRACTICES/OTHER
1. What are your business hours? Please enter your earliest
start time and latest closing time.
Day
Start Time
End Time
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
2. During what part of the year is your business open? Check
one of the following.
Full year School year only Summer only
3. On what time basis do you accept children? Check one of
the following.
Full-time basis (more than 30 hours/week)
Part-time basis (30 hours/week or less)
Both
4. What schedules do you accept? (Check all that apply)
Drop-in (infrequent care)
Temporary/emergency (short-term, back-up care)
Before school
After school
Open holidays
24-Hour (occasional basis)
Rotating (Example: M-W one week, T-TH next week)
None of the above
5. Does your program have indoor or outdoor pets
?
YES NO
6. Does your program have an outdoor play area that is
completely fenced in?
YES NO
7. Is your program wheelchair accessible?
YES NO
8. Do you limit your enrollment to a specific group (for
example, employees of a specific business or tenants of a
specific building)?
YES NO
9. Are at least 50% of the children enrolled in your program of
American Indian heritage?
YES NO
If yes, you may be contacted by MNTRECC for tribal specific
services.
10. Do you currently serve homeless children? Homeless
includes families living in shelters, cars, outside, public
spaces, or motels due to lack of accommodation and
families doubling up temporarily due to hardship.
YES NO
11. In which School District are you located?
If you do not know the district number, please look it up at:
www.gis.leg.mn/OpenLayers/schooldistricts/
District Number ____________________________
12. To which Elementary School(s) is your address assigned?
__________________________________________
13. Select all languages used in your program.
English Spanish Hmong Somali
Karen Arabic Oromo
American Sign Language Ojibwe
Dakota Other ___________
SECTION E: TRAINING & EXPERIENCE
1. Select all special needs trainings or experience earned by all program staff.
Developmental Delay (such as autism, speech,
cognitive, social, and/or motor delays)
Emotional/behavioral (such as ADHD/ADD)
Hearing Impaired
Visually Impaired
Special Health Needs (such as asthma, special diet or
Hepatitis B)
Physically Challenged
I do not have special needs training and/or experience
Thank you for completing the Provider Business Update
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Child Care Center Business Form (Childcare Aware MN)

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Completed 4 August 2020

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