First Name Last Name Your Phone Your Email Your Street Address Your Zipcode Are you currently serving families and running a child care business? Are you currently serving families and running a child care business? Yes No If so, how long have you been open? Are you currently licensed? Are you currently licensed? Yes No What type of license do you currently hold or plan to hold? What type of license do you currently hold or plan to hold? Registered Family Certified Family Child Care Center None/Other Have you, and anyone else in your home over 18, completed a background check and are enrolled in the Central Background Registry? Have you, and anyone else in your home over 18, completed a background check and are enrolled in the Central Background Registry? Yes No In process Submit
