Childcare Provider Telephone Questionnaire /Interview

Date:______________


Name:__________________________________________________________

Address:_________________________________________________________

Telephone:______________________________________________________



1. Do you have openings for my child(ren)?____________________

2. Will you be available to keep my child(ren) _____days a week?__________________

3. What is the cost for this care?_____________________________________________

4. What does this include?__________________________________________________

5. Are there any other cost?_________________________________________________

6. How many children do you currently provide for?_____________________________

7. What are the ages of the children who will be in my child's classroom or care in home?_________________________________

8. Is the building or home smoke free?_______________________

9. Do you have any pets?________________________________

If yes, what type of animals and where are they during the hours you are caring for children?______________________________________________________

10. What would be the routine and the types of activities for my child(ren)?_________________________

11. What are your discipline practices?_____________________________________

12. Are you licensed, registered, or exempt from licensure?_______________________

My impression of the provider:_____________________________________

References
Modified from
Division of Childcare and Development
Virginia Department of Social Services
Richmond,VA