This form, developed by a family child care association would come in handy for those of you that are brave enough to solicit an exit evaluation.

Association_____________Other______________

2. Are you familiar with the association

_____yes____no

3. Are you comfortable with your rates?

_____yes____no

4. Do you find the contract to strict?

______yes____no

If YES, explain: ____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

5. Do you think the contract is fair to both you and the provider?

________yes______no.

If NO, explain: ____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

6. How do you rate the providers overall performance?(0-10)

___________________________________________________

7. Do you feel your provider has a positive attitude daily?

_________yes_________no

8. Does your provider share positive feelings and interact well with children of all ages?

__yes___no.

If NO, explain: ____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

9. Would you recommend your provider to others seeking quality child care services?

___________yes________no

10. Do you feel your provider is a professional day care provider or a baby sitter?

________________________________________________________________

11. Is the day care home clean and well equipped for your childs' age?

__________yes________no,

If NO, explain ____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

12. Would you like these comments shared with your provider?

_______yes________no

Additional comments: ____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________