4. ENROLLMENT – Provide information regarding ratios, group sizes and capacity. Please enter N/A for any fields that are not applicable to your program. *REQUIRED CARE LEVEL LICENSED RATIO ACTUAL RATIO (The ratio you choose for your program if different from licensing ratio) GROUP SIZE (Number of children you choose to house in each classroom. If there is more than one age group, please use the largest group size) INFANT (Less than 12 months) Adult : Child : Adult : Child : TODDLER (12 months to less than 24 months) Adult : Child : Adult : Child : 2 YEAR OLD (24 months to less than 36 months) Adult : Child : Adult : Child : 3 YEAR OLD (36 months to less than 48 months) Adult : Child : Adult : Child : 4 YEAR OLD (48 months to less than 60 months) Adult : Child : Adult : Child : 5 YEAR OLD (60 months to less than 72 months) Adult : Child : Adult : Child : ELEMENTARY SCHOOL AGE Adult : Child : Adult : Child : MIDDLE SCHOOL AGE Adult : Child : Adult : Child : CAPACITY LICENSED CAPACITY (Number of children you are licensed to care for) ACTUAL CAPACITY (Most number of children you choose to care for) 5. ENVIRONMENT - Describe your program’s setting and any languages spoken by program staff. (Check all that apply) *REQUIRED CHINESE NO TV WEBCAM ON SITE OTHER (List Below) CREOLE PETS WHEELCHAIR ACCESSIBLE ENGLISH POOL ON SITE OTHER (List Below) FENCED YARD PORTUGUESE FILIPINO RUSSIAN FINANCIAL ASSISTANCE SCHOOL READINESS PROVIDER FRENCH SEPARATE PLAY AREA (FCCH) GERMAN SIGN LANGUAGE GREEK SMOKE FREE GREEN CERTIFIED SPA HEBREW SPANISH ITALIAN VIDEO MONITORING
9. RATES: Enter the advertised rates (private pay rates) your program charges in the table below. 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). *REQUIRED 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 10. SCHEDULE - What days of the week does your program operate? Describe your program schedule. (Check all that apply) *REQUIRED 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) 24-Hour Care Full Time School Syst Weather Days After School Full Year School Year Before School Overnight sWING SHIFT Drop In Care Part Time Weekend Emergency/Temporary Care Respite Care Evening Care Summer Only 11. ENHANCED SERVICES - What other services does your program offer? (Check all that apply) *REQUIRED Art/Crafts Music Lessons environ accommodations Computers Kindergarten Class Training/exp dev delay Dance On-site Screenings Therapeutic Services Family involvement Outdoor Sports OTHER (List Below) Field Trips Swim Lessons Gymnastics Training/exp autism Homework/Tutor Training/exp behav chal