Infant/Toddler Childcare Start Up Application Form Please check one of the following: * I want to start my own Infant & Toddler childcare business I’m not ready to commit just yet, but please add me to your email newsletter list I am an existing child care provider and want to receive the email newsletter I have a business and want to help the initiative Name * First Name Last Name Name of Business (if applicable) Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Cell Phone * (###) ### #### Landline (###) ### #### How did you hear about us? Tell us a little about yourself Thank you!