ࡱ> &(%5@ bjbj22 (XX8888888L LX D  $ R 8 88 88   88  h3J ( 0X ?L LL88888  LL$p$LLp Child Care Evaluation Form Childs Name: Date of enrollment: Providers Name: Hours your child is in care: Please answer the following questions on the scale of one to five. (One being completely dissatisfied and five being totally satisfied or in total agreement) 1. The day care provider shows my/our child one on one attention and affection. 1 2 3 4 5 2. The day care providers home environment is one I/we are comfortable with. 1 2 3 4 5 3. My/our child seems to be thriving well under the day care providers care. 1 2 3 4 5 4. My/our child seems content and happy to be with the day care provider. 1 2 3 4 5 5. The day care provider seems knowledgeable about child-care. 1 2 3 4 5 6. The day care provider tells me/us about my/our childs daily activities. 1 2 3 4 5 7. The day care provider is communicative with the parents/guardian. 1 2 3 4 5 8. My/our child is well taken care of by the day care provider. 1 2 3 4 5 9. I/we believe that the day care provider is working together with me/us to help provide my/our child a safe, healthy and happy childhood. 1 2 3 4 5 In the space below please clarify why you have any dissatisfaction with the day care providers services or environment. Also make any comments or suggestions that you believe would help to improvement your day care experience. Please use the below area to briefly explain what it is that you most like about your provider and their day care services. Mothers Signature Date Fathers Signature Date Providers Signature Date +1FJ\a   ?[bdhǽڨڨڤh)4h)4>*CJOJQJhJ\^CJOJQJh)4CJOJQJ h)4aJh)4>*CJOJQJaJh)4CJOJQJaJ hJ\^hJ\^h)4CJ,aJ,hJ\^h)4CJ,aJ, K# i V i  k ?M[\hgdJ\^gdJ\^h&1h:pJ\^/ =!"#$%@@@ NormalCJ_HaJmH sH tH F@F Heading 1$$@&a$ CJ OJQJDA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k@(No List D>@D Titledd[$\$OJPJQJ^J8J@8 Subtitle$a$5\:B@: Body Text CJOJQJK#iV ik?M[\h000000000000000000000000000000000O90zh  8@0(  B S  ?jsHL[_ ls33333333333!"Richard & Michelle HodgeMedical ExchangeMedical ExchangeMedical ExchangeMedical ExchangeMedical ExchangePreferred CustomerJ\^)4@ __P@UnknownG:Times New Roman5Symbol3& :ArialCFComic Sans MSIArial Unicode MS"hdtƕdt  A243QH(?J\^Child Care Evaluation FormRichard & Michelle HodgePreferred Customer Oh+'0x  4 @ LX`hpChild Care Evaluation FormhilichichNormal Preferred Customer2Microsoft Word 10.0@G@-J@-J ՜.+,0 hp|    A Child Care Evaluation Form Title '*Root Entry F)1Table WordDocument(SummaryInformation(DocumentSummaryInformation8 |CompObjj   FMicrosoft Word Document MSWordDocWord.Document.89q Oh+'0x  4 @ LX`hpChild Care Evaluation FormhilichichNormal Preferred Customer2Microsoft Word 10.0@G@-J@-J ՜.+,D՜.+,H hp|    A Child Care Evaluation Form Title4 $,