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) 324-8461

Physical Address
700 W ADAMS ST
BOWLING GREEN
MO 63334-2046

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

Mailing Address
614 KELLY LN
LOUISIANA
MO 63353-2409

Provider/Director
SNELL, DEBRA JUNE

E-mail Address
cassie.spangler@twinpikefamilyymca.org

Incorporated
Incorporated

Child Care Specialist
JOY LYNN NICHOLS

Age Range
5 YEARS - 13 YEARS

Capacity
120

Facility Type
SCHOOL AGE

Limitations

Inspection Information

Date
11/17/2021

Arrival Time
4:25 PM

Departure Time
5:26 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2413144860

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	02/14/2019
STAFF SHEET	04/08/2019
ANNUAL DECLARATION	05/14/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	05/14/2021
EQUIPMENT LIST	05/14/2021

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 29

Staff	Child	Class Age	Note
2	7	SCHOOL AGE	ages 5-6; Linda Arnold and Angie Derr
1	8	SCHOOL AGE	ages 7-8; Pam Watts
1	11	SCHOOL AGE	ages 9-12; Sidney Thomas
1	3	SCHOOL AGE	ages 5-6; Cheryl Becker