Daycare Center Form

	Daycare Choices		Family Daycare		Daycare Centers		After School Care		Daycare Checklist		Licensing

You have elected to pay by check for a Family Daycare membership. If this is incorrect and you want to use PayPal, click here.

Fill in the form below and add your daycare to the Daycare Network. It is important that you fill in all the fields!

Name of Business:
Type of Daycare:
Contact:
Address:
City:
State:
Zip Code:
License Number:
Phone:
Email:
Nearest Elem School:
Accept Infants:	Yes No
Before/After School:	Yes No
Hours of Operation:
Drop-off Time:
Pick-up Time:
Lunch Provided:	Yes No Not Applicable
Snacks Provided:	Yes No
Referred By:
Name of referring friend
Describe "Other"
Description: (how long you've been in business, certifications, activities you do with the children, etc.)

Do You Want A Coupon?	Yes No
Describe Coupon Offer: