Family Child Care Home Provider Update Form

CCCC offers free child care referrals to parents in Kern County, California. Please complete the form below with your updated information so that we can update our records. Complete only the items that apply to your business. This form is for child care programs in Kern County, California only.
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Please note: On-line update information will be used by CCCC for child care referral purposes only. Information will not be shared with any other child care referral service.

Family Child Care Provider Name

Business Name

Street Address

Zip Code

Major Cross Streets (Example: 24th Street and F Street)

Home phone number (Include area code)

Phone number parents should call (Include area code) Same as home number

Fax number (Include area code)

Email address (Example: kisilva@kern.org)

Current Openings: Please update your openings every 3 weeks
Number of vacancies
Date vacancy is expected --mm/dd/yy

How many children are you licensed for?

What ages do you care for? From to
When applicable, please indicate weeks, months and/or years for ages.

Do you prefer to care for a narrower age group? Yes No
If "yes", what ages? From to
When applicable, please indicate weeks, months and/or years for ages.

Check all the days that you provide care and the start time and end time each day:
Monday Tuesday Wednesday Thursday Friday Saturday Sunday

What time do you provide care?
Start time End time

Do you operate All year long During the school year ONLY Summer ONLY

Do you provide Before-and-After-School care? Yes No
If "yes", what ages?

Name(s) of Elementary School(s) near business

Is there a school bus stop near your facility? Yes No
If "yes", to which schools?

Do provide transportation? Yes No
If "yes", to which schools?

Do provide transportation to/from child's home? Yes No

What do you charge?: (This information is for CCCC internal purposes only and will not be given out to parents)
greyarrow: Infant/Toddler (Age 0-23 months)
$ per (full time)
$ per (part time)

greyarrow: Preschooler (Age 2-5 years)
$ per (full time)
$ per (part time)

greyarrow: Kindergartener and up
$ per (full time)
$ per (part time)

Can you, or persons on your staff, converse in a language other than English? Yes No
If yes, please list languages

Are you a part of the Community Connection for Child Care Food Program (CCFP)? (What is this?)
Yes No
If "no", would you like a CCFP representative to contact you about enrolling? Yes No

Do you or your staff have any experience in providing care for children with special needs? Yes No

If "yes", what training, experience and/or accomodations does you and your staff have?

Would you like to share any other information about your family child care business to help parents learn more about your program?

Based on your knowledge of CCCC services, please grade the quality of services you received from CCCC.
Excellent Very Good Average Fair Poor

As a result of your experience with the Resource & Referral/Resource Library, what service-related improvements can you suggest?

Thank you for taking the time to complete this form. Please click the Submit Form button to send us your information.


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