MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
TWIN PIKE FAMILY YMCA

Facility DVN
001779428

Phone
(573) 754-6904

Physical Address
500 HALEY AVE
LOUISIANA
MO 63353

Owner
TWIN PIKE FAMILY YMCA

Mailing Address
614 KELLY LN
LOUISIANA
MO 63353-2409

Provider/Director
MILLER, KAY

E-mail Address
BROOKSM@LOUISIANA.K12.MO.US

Incorporated
Incorporated

Child Care Specialist
TRACY MARSHALL

Age Range
5 YEARS - 15 YEARS

Capacity
120

Facility Type
SCHOOL AGE

Limitations

Inspection Information

Date
09/24/2013

Arrival Time
3:00 PM

Departure Time
4:30 PM

Notice
ANNOUNCED

Inspection Type
RENEWAL

Inspection ID
2210341310

Document	Document-Date
APPLICATION	09/24/2013
STAFF SHEET	09/24/2013
EQUIPMENT LIST	09/24/2013
DIRECTOR'S QUALIFICATIONS	09/24/2013
CERTIFICATE OF GOOD STANDING	09/24/2013
DAILY SCHEDULE	06/01/2004
SAMPLE WEEKLY MENU	09/05/2003
POLICIES	09/05/2003
LINES OF ADMINISTRATIVE AUTHORITY	08/27/2007
SAMPLE FORMS	09/05/2003

Inspection determined facility to be in compliance with licensing rules.

Open Violations: NA

NOTE

The licensee is responsible for compliance with all licensing rules, including but not limited to the rules listed on this compliance report form.

Attendance at Time of Inspection

Total Staff 5

Total Children 55

Staff	Child	Class Age	Note
5	55	SCHOOL AGE