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
002064402

Phone
(573) 324-9991

Physical Address
700 W ADAMS
BOWLING GREEN
MO 63334

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

Mailing Address
614 KELLY LN
LOUISIANA
MO 63353

Provider/Director
GENENBACHER, KARINA KAYE

E-mail Address
bg21stcclc@SBCGLOBAL.NET

Incorporated
Incorporated

Child Care Specialist
JOY LYNN NICHOLS

Age Range
5 YEARS - 13 YEARS

Capacity
120

Facility Type
SCHOOL AGE

Limitations

Inspection Information

Date
11/28/2018

Arrival Time
3:25 PM

Departure Time
4:11 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2345163373

Document	Document-Date
SAMPLE FORMS	09/04/2007
LINES OF ADMINISTRATIVE AUTHORITY	08/27/2007
LOCAL FIRE DEPARTMENT NOTIFICATION	09/04/2007
DIRECTOR'S JOB RESPONSIBILITIES	09/04/2007
DIRECTOR'S QUALIFICATIONS	04/09/2009
DAILY SCHEDULE	09/04/2007
CHILD CARE PRACTICES	10/02/2007
CERTIFICATE OF INCORPORATION	09/04/2007
CERTIFICATE OF GOOD STANDING	03/07/2012
ARTICLES OF INCORPORATION	09/04/2007
APPLICATION	03/15/2017
STAFF SHEET	04/21/2017

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 8

Total Children 77

Staff	Child	Class Age	Note
2	17	SCHOOL AGE	Linda Arnold and Karen Shinn
2	15	SCHOOL AGE	Cheryl Becker and Cindy Cerven
1	8	SCHOOL AGE	Jen Dyer
1	12	SCHOOL AGE	Karen Allen
1	12	SCHOOL AGE	Stephanie Sellars
1	13	SCHOOL AGE	Angie Derr