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CHILDCARE PROVIDERS
GARLAND & RICHARDSON CHILDCARE ASSOCIATION
MEMBERSHIP APPLICATION
NAME: ________________________________________________________________
ADDRESS: _____________________________________________________________
CITY: _________________________________________________ ZIP:_____________
PHONE: ____________________________________
BIRTH DATE: _______________
E-MAIL ADDRESS ________________________________________________________
WHAT IS YOUR NEAREST MAJOR INTERSECTIONS? __________________________________________________________________________
WHAT AGES OF CHILDREN DO YOU PREFER: INFANTS_____ TODDLERS______
SCHOOL AGE_________ WILL YOU DO BACK-UP OR DROP-IN CARE? __________
WILL YOU PROVIDE NIGHT CARE? __________WEEKEND CARE? ___________
WILL YOU BE TRANSPORTING CHILDREN? _____________________________
WHAT IS YOUR NEAREST ELEMENTARY SCHOOL? ____________________________
STATE REGISTRATION# ________________ CITY OF RICHARDSON# _________
A COPY OF YOUR CURRENT CHECK SENT TO T.D.P.R.S. FOR LISTING OR REGISTRATION, (OR IN PROCESS) IN ORDER TO RECEIVE REFERRAL.
PLEASE CHECK AREAS OF TRAINING YOU ARE MOST INTERESTED IN:
INFANT AND CHILDHOOD DEVELOPMENT ________
HEALTH AND SAFETY_________ DAYCARE TAXES _______________________
PROFESSIONALISM ___________ CULTURAL, INDIVIDUAL DIVERSITY ______
HEALTH AND SAFETY _____________ MARKETING YOUR BUSINESS ________
I AGREE TO SUPPORT AND UPHOLD THE BYLAWS OF THE CHILDCARE PROVIDERS GARLAND & RICHARDSON CHILDCARE ASSOCIATION.
SIGNATURE: __________________________________ DATE: __________________
