Registration Membership Registration Business Structure*For-ProfitNon-ProfitName of Governing Body/Owner* Governing Body/Owner Address* Street Address Address Line 2 City State / ProvinceAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone for Governing Body/Owner*Email for Governing Body/Owner* Enter Email Confirm Email Website Program Name (s)* Contact Person or DirectorName* First Last Phone*Email* Address (if different than above) Street Address Address Line 2 City State / ProvinceAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Is:* Owner Director Assistant Director Other If Other: Program StatisticsTotal License Capacity*Enter #'s for each program or N/A Colorado Shines Rating*Enter #'s for primary program or N/A (we will capture the rest off of the state list)Not ProvidedMultiple locations/different ratingsOne-StarTwo-StarThree-StarFour-StarFive-StarNo RatingTotal Full Time Staff For All Programs*Enter # or N/ATotal Part Time Staff For All Programs*Enter # or N/A Accredations NAEYC NECPA Montessori No Accreditation Other Ages Served Infants Toddlers Preschoolers School Agers Enrollment StatisticsTotal Full Time Children in Care in Programs*Enter number herePlease enter a number from 0 to 99999.Total Part Time Children in Care in All Programs*Enter number herePlease enter a number from 0 to 9999.LocationsCenter/Preschool locations with license capacity of 15 or fewer children:Select number (up to 2 locations)0123456789101112131415161718192021222324252627282930Center/Preschool locations with license capacity of 15 or fewer children:Select number for additional (locations 3+)0123456789101112131415161718192021222324252627282930Center/Preschool locations with license capacity of 16 or more children:Select Number (up to 2 locations)0123456789101112131415161718192021222324252627282930Center/Preschool locations with license capacity of 16 or more children:Select Number for additional (locations 3+) 0123456789101112131415161718192021222324252627282930Locations that are a licensed family child care home:01Locations with B&A School Program:Select number for up to 2 locations0123456789101112131415161718192021222324252627282930Locations with B&A School Program:Select number for additional (locations 3+)0123456789101112131415161718192021222324252627282930List All Location AddressesMembership DuesMembership dues are based on program type/size and how many site locations. All programs for the governing body should be included in membership. The price break down is: $50 Family Child Care Home $6o School aged Program (first 2 locations each) $50 School aged Programs (location 3+ each) $200 Small Center (first 2 locations each) $120 Small Center (location 3+ each) $250 Large Center (first 2 locations each) $140 Large Center (location 3+ each) All new registrations are subject to administrator approval. Currently 15% of your dues and contributions may be tax deductible as a business expense. 85% of membership dues in 2021 support our lobbying and are not tax deductible. Upon completion of this form you will receive an invoice within 24 business hours. Total membership dues are calculated here:*
