Daycare Provider Notification of Licensing or Registrationvisitpiketownship_ouclgu2022-06-10T08:28:45-04:00

Daycare Provider Notification of Licensing or Registration

Name of Provider / Program*
Email*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Type of Service*
Maximum Number of Children Licensed or Registered to Care For*
Years of Age Range of Children Cared For*
(Ex. 5 to 10)
I provide child day care on the following days and times:
Monday
- Monday
Open

: Hours

Minutes

AM/PM
Close

: Hours

Minutes

AM/PM
Tuesday
- Tuesday
Open

: Hours

Minutes

AM/PM
Close

: Hours

Minutes

AM/PM
Wednesday
- Wednesday
Open

: Hours

Minutes

AM/PM
Close

: Hours

Minutes

AM/PM
Thursday
- Thursday
Open

: Hours

Minutes

AM/PM
Close

: Hours

Minutes

AM/PM
Friday
- Friday
Open

: Hours

Minutes

AM/PM
Close

: Hours

Minutes

AM/PM
Saturday
- Saturday
Open

: Hours

Minutes

AM/PM
Close

: Hours

Minutes

AM/PM
Sunday
- Sunday
Open

: Hours

Minutes

AM/PM
Close

: Hours

Minutes

AM/PM

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