In-Home Childcare FormSeptember 23, 2025 Your Name* Address1* Address 2 City* State* Zip* Phone Number* (XXX-XXX-XXXX) Email Address* I operate a licensed childcare? Yes No If no, are you planning to obtain license within 12 months? Yes No I agree to take the budgeting class? Yes No I agree to obtain 3 bids for any required updates needed? Yes No Tell us what help you need at your childcare (check all that apply): Exit Window Basement Door Fence Sinks Smoke Detectors GFI Outlets Other Help Today's Date*
