Application to Join Association
Name ___________________________________________ Date ________
Street Address ___________________________________
City _________________________ State _____ Zip Code ___________Home Phone __________________ Cell Phone _____________________ E-mail _________________________________ Name of your daycare ________________________________ Are you State Licensed _____ Are you State Contracted _____ (You do not have to be State Licensed to join our Association) Your Elementary School District ____________________________ Do you care for children now? _____ What ages? _____ How many children would you like to care for? _______ Do you or would you consider caring for Special Needs Children? ________ Are you CPR/FirstAid Certified? ___________ What are your hours of operation? ________ What days of the week are you open? ______Would you like your address on Web site Please send 75.00 dollars along with your membership application to: Debbie Clark Blue Springs Child Care Association 3605 N.W. Valley View Pl.Blue Springs Mo.64015
For All your child care forms go to https://health.mo.gov/safety/childcare/forms.php