Emergency Preparedness Registration: Are you prepared?

Welcome family child care providers! Thank you for taking the first step toward ensuring the safety and preparedness of you, the families you serve, and your business. By participating in this survey, you're on your way to joining our Emergency Preparedness Peer-to-Peer Network (PPN). Let's get started!

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* 1. The Emergency Preparedness Peer-to-Peer Network (PPN) is open to licensed family child care providers only.
As a PPN, this is not eligible for clock-hour training but instead, it is an opportunity to gain valuable insight and strategies. Click the box if you agree to the above.

Agree

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* 2. Full Name

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* 3. Date of Birth MM/YYYY

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* 4. Which race/ethnicity best describes you? (Choose only one.)

White/Caucasian

Black/African American

Hispanic/Latino

Asian/Asian American

American Indian/Alaska Native

Native Hawaiian/other Pacific Islander

Other (please specify)

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* 5. What gender do you most identify with?

Male

Female

Prefer not to answer

Prefer to self describe below

Self-describe:

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* 6. Mobile phone number with three-digit area code (xxx-xxx-xxxx)

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* 7. Valid email address

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* 8. Business address

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* 9. Business zip code

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* 10. What are your hours of operation? (ex: 6:30 am to 6:00 pm, Mon to Fri)

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* 11. What is your DVN #

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* 12. How many children do you currently have in your care?

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* 13. How many children under 2 do you currently have in your care?

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* 14. Do you take subsidy?

Yes

Other (please specify)

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* 15. How many years in total have you been in the child care field?

less than a year

1 to 4 years

5 to 9 years

10 to 14 years

15+ years

N/A

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* 16. How many years have you been a family child care provider?

less than a year

1 to 4 years

5 to 9 years

10 to 14 years

15+ years

N/A

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* 17. Do you consider the area you serve to be: (check all that apply)

Rural

Suburban

Urban

Not sure

Emergency Preparedness Registration: Are you prepared?

Question Title

* 1. *The Emergency Preparedness Peer-to-Peer Network (PPN) is open to licensed family child care providers only. * As a PPN, this is not eligible for clock-hour training but instead, it is an opportunity to gain valuable insight and strategies. Click the box if you agree to the above.

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* 2. Full Name

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* 3. Date of Birth MM/YYYY

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* 4. Which race/ethnicity best describes you? (Choose only one.)

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* 5. What gender do you most identify with?

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* 6. Mobile phone number with three-digit area code (xxx-xxx-xxxx)

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* 7. Valid email address

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* 8. Business address

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* 9. Business zip code

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* 10. What are your hours of operation? (ex: 6:30 am to 6:00 pm, Mon to Fri)

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* 11. What is your DVN #

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* 12. How many children do you currently have in your care?

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* 13. How many children under 2 do you currently have in your care?

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* 14. Do you take subsidy?

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* 15. How many years in total have you been in the child care field?

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* 16. How many years have you been a family child care provider?

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* 17. Do you consider the area you serve to be: (check all that apply)

* 1. The Emergency Preparedness Peer-to-Peer Network (PPN) is open to licensed family child care providers only.
As a PPN, this is not eligible for clock-hour training but instead, it is an opportunity to gain valuable insight and strategies. Click the box if you agree to the above.