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.

    Evaluation Form
    HOW AM I DOING?

                       

1.  How did you get the providers phone number?
     
    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:___________________________________________________

     _______________________________________________________________________

     _______________________________________________________________________

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