CCR&R Bridgerland

New Provider Information

To receive information on becoming a child care provider in Cache, Box Elder or Rich County, call 435-797-1552 or 1-800-670-1552 during business hours or submit this form and we will contact you within one business day.
Contact information
Full Name:*
Email Address:
Phone Number:*
Address (street):*
City:*
County:*
Zip Code:*

Licensing and Training Information
Have you been licensed before?	Yes: No:
If yes, when and where?

Have you already started the licensing or Residential Certificate process?	Yes: No:

Are you interested in registering for the Sharing the Caring Class?	Yes: No:
(Learning about policies & procedures for family child care. This class is for new providers and is needed for licensing or Residential Certificate credit.)
If YES, list which month you plan on attending:

How did you find out about us?

How would you like us to contact you?	Email: Phone: Packet by Mail:

Any other comments or questions?

* Denotes required fields

New Provider Form

Child Care Resource & Referral Bridgerland Region is a program of Utah State University - College of Education & Human Service, Department of Family Consumer and Human Development. Utah State University is an affirmative action/equal opportunity employer. Funding is made possible by a grant from the Utah Department of Workforce Services - Office of Work & Family Life, Office of Child Care.