Child Care Provider Registration/Update

Required questions are marked with a *.

Fill out the form below to register your program with ACAP RDC. If you are already registered with us, you may use this form to update your information.

*First Name, *Last Name:
Job Title:
Program Name:
*Address:
 
*City *State, *Zip Code: ,
*Phone: (include area code)
Fax:
Email Address:
Directions to your site:
How long have you been in operation? Month and Year:
Center Family Child Care
School-Age Nursery School/Preschool
Camp Other
*Type of Program:
If other, please explain:
*Ages of Care:
Infant Toddler
Preschool Kindergarten
School Age Other
Total Capacity:
License Expiration Date:
Schedule of Care: Hours:
Full Time Part Time
Both Other
If other, please explain:
Hours and Days of the Week that the Program is Open:
Monday: Tuesday:
Wednesday: Thursday:
Friday: Saturday:
Sunday:  
Sessions:
Year Round School Year Only
Summer Only Other
Do you offer Weekend or Evening Care:
What are your weekend and evening rates?
Are meals provided?
Yes No
If so, which ones?
Do you have any pets?
Yes No
Do you use a written agreement (contract) with parents?
Yes No
How many vacations do you take per year?
Are they paid or unpaid?
Paid Unpaid
some paid, some unpaid
Transportation
Is transportation provided?
Yes No
Is the program close to public transportation?
Yes No
If so, what kind?
Is the program near school bus routes?
Yes No
Elementary School(s) whose
bus routes the program is on:
Approximate Distance:
 
Fees:
Hourly Daily
Weekly Monthly
Yearly Other
Please list your full-time fees according to age group:
Please list your part-time fees according to age group:
Do you offer a sibling discount?
Yes No
If so, please explain:
Please list all forms of financial assistance that you offer or accept.
Staff Training and Experience
Are all staff/providers trained in CPR?
Yes No
Are all staff trained in First Aid?
Yes No
Please describe staff education, degrees, and experience.
Please describe staff experience with special needs.
Is there anything else about your program
that you would like us to know?
Do you have current openings?
Yes No
If you have openings, please indicate what age group you have openings for.
Please indicate how many infants, toddlers, preschoolers, and school-age children that you currently have enrolled.
 

Thank you for taking the time to complete this form.
Please click the submit button below to send us your information.
We will be contacting you soon.

 
Contact info:  
Aroostook County Action Program
Resource Development Center
PO Box 1116/771 Main Street
Presque Isle, ME 04769 		 

 
 

771 Main Street
Presque Isle, ME 04769
(207)764-3721
1-800-432-7881

342 West Main St.
Suite 102
Fort Kent, ME  04743
(207)834-5135

91 Military St.
Houlton, ME  04730
(207)532-5311

88 Fox St.
Madawaska, ME  04756
(207)728-6345
 
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