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Provider Update Form
Please use this form to inform Child Care Services Association if your facility has made any changes in its response to the current COVID-19 public health crisis. Please call us at 919-403-6950 or email us at
referral@childcareservices.org
if you have any questions or concerns.
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* Indicates required question
Facility License Number (if applicable):
Your answer
Facility/Camp Name
*
Your answer
Facility Type
Licensed Child Care Center
Licences Family Child Care Home
School Age Program
Unlicensed Preschool Program
Camp
Other:
Clear selection
City where facility/camp is located
*
Your answer
County
Alamance
Caswell
Durham
Franklin
Granville
Orange
Person
Vance
Wake
Other:
Clear selection
Name of person completing this form
*
Your answer
Who should we contact in the event your site is closed due to the current public health concerns surrounding COVID-19?
*
Your answer
What is the e-mail address for this contact person?
*
Your answer
What is the phone number for this contact person?
*
Your answer
What is the preferred way to reach this person if your facility is closed?
*
Email
Phone
Other:
Required
What are your intended plans for operation during the coming weeks?
*
We will follow our county's school system regarding closure
We will follow DCDEE guidance regarding closure
We will close only if a staff or family member at our site tests positive for COVID-19
We do not have plans to close and are still accepting new enrollments.
We do not have plans to close but we are NOT accepting new enrollments.
We do not have plans to close and are open to accepting children on an emergency, short-term basis (for example, children whose primary care provider has closed)
We plan to offer full-time Schoolage care for children who are out of school due to school closures
We are reopening after a closure (please include the date you are reopening in the next question)
Other:
Required
If you are reopening, what date will you reopen?
MM
/
DD
/
YYYY
If you are closing, what date will you close?
MM
/
DD
/
YYYY
If you are closing, what date do you plan to reopen?
MM
/
DD
/
YYYY
If you are still accepting new enrollments, what ages are you currently accepting?
Infants
Toddlers
Twos
Threes
Fours
Fives
Schoolage
If you have children who are unable to attend care for an extended period of time (due to illness or quarantine), do you plan to hold the child's spot?
Yes
No
Maybe
Other:
Clear selection
Is there anything else it would be helpful for us to know about your plans regarding closure or enrollment during this time?
Your answer
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