MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
TRI-STATE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION

Facility DVN
002083687

Phone
(417) 455-9999

Physical Address
12350 NORWAY RD
NEOSHO
MO 64850-6632

Owner
TRI-STATE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION

Mailing Address
4701 CHOUTEAU DR
NEOSHO
MO 64850-9123

Provider/Director
KEPLAR, CLARA ALICE

E-mail Address
tina@tristatefamilyymca.org

Incorporated
Incorporated

Child Care Specialist
ANGEL DONSON

Age Range
5 YEARS - 12 YEARS

Capacity
60

Facility Type
SCHOOL AGE

Limitations
AFTER SCHOOL CARE ONLY

Inspection Information

Date
04/04/2023

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2444362307

Document	Document-Date
POLICIES	08/08/2007
JOB RESPONSIBILITIES	08/08/2007
DAILY SCHEDULE	08/08/2007
ARTICLES OF INCORPORATION	08/08/2007
LINES OF ADMINISTRATIVE AUTHORITY	01/03/2008
CHILD CARE PRACTICES	08/08/2007
DISCIPLINE POLICIES	08/08/2007
CERTIFICATE OF GOOD STANDING	10/09/2015
STAFF SHEET	11/13/2019
APPLICATION	11/13/2019
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	02/15/2023
EQUIPMENT LIST	02/15/2023
ANNUAL DECLARATION	02/15/2023

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.