Child care providers may report changes in holidays, emergency closures and other changes using the form below.

Select County from the drop-down menu first to filter the list of providers. Contact information will be populated with data on file; make any changes to name, phone number or email address before submitting the form.

County*
Provider Name*
(CCS Provider Number)
Contact Person*
Daytime Phone*

Email Address*

Changes to be reported (check all that apply)
All licensed and registered providers with a CCS Agreement can be paid for up to nine (9) holidays per year.  All holidays must be requested at least two weeks prior to the holiday in order to receive payment. Holidays must be during normal business days.
Date 1 Date 2 Date 3
Date 4 Date 5 Date 6
Date 7 Date 8 Date 9
All licensed and registered providers with a CCS Agreement can request removal of holidays when the provider plans to remain open.  All removals must be requested at least two weeks prior to the holiday.
Date 1 Date 2 Date 3
Date 4 Date 5 Date 6
Date 7 Date 8 Date 9
Date(s) of Closure
Reason for Closure
Additional days the provider plans to close that will not be paid by CCS.
Date 1 Date 2 Date 3
Date 4 Date 5  
   Other Changes