Common Contracts
1 similar Provider Agreement contracts
ContractProvider Agreement • September 4th, 2019
Idaho Department of Health and Welfare Idaho Child Care Program (ICCP) Provider Agreement Section A THIS IS AN AGREEMENT BETWEEN THE IDAHO CHILD CARE PROGRAM AND: Business Name (if applicable) Owner Name Director Name Contact Information Phone Secondary Phone Email Address Physical Address (where child care is taking place) Street Address City State Zip County Mailing Address (if different from above) Street Address or P O Box City State Zip Social Security Number OR Federal Tax Identification Number Check one (1) Type of Care for you or your facility: Please note: each child (age 12 and younger) in the setting counts as one (1) child, including relatives, friends, neighbors, foster children, and the provider’s own children. Day Care/Child Care Center Facility - I provide care for 13 or more children. Group Care Facility - I provide care for a maximum of 12 children. Family Care Facility - I provide care for a ma
