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 YOUNG MEN'S CHRISTIAN ASSOCIATION, INC

Facility DVN
001779428

Phone
(573) 754-6904

Physical Address
500 HALEY AVE
LOUISIANA
MO 63353

Owner
TWIN PIKE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC

Mailing Address
614 KELLY LN
LOUISIANA
MO 63353-2409

Provider/Director
SHEPHERD, NOVETA A

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

Incorporated
Incorporated

Child Care Specialist
JOY LYNN NICHOLS

Age Range
5 YEARS - 13 YEARS

Capacity
96

Facility Type
SCHOOL AGE

Limitations

Inspection Information

Date
10/31/2017

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2316798120

Document	Document-Date
STAFF SHEET	09/06/2017
EQUIPMENT LIST	09/06/2017
APPLICATION	08/24/2017
SAMPLE FORMS	09/05/2003
LINES OF ADMINISTRATIVE AUTHORITY	08/27/2007
POLICIES	09/05/2003
SAMPLE WEEKLY MENU	09/05/2003
DAILY SCHEDULE	06/01/2004
CERTIFICATE OF GOOD STANDING	09/24/2013
DIRECTOR'S QUALIFICATIONS	09/24/2013

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.