MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
THE ADAIR COUNTY FAMILY YMCA, INC.

Facility DVN
002892768

Phone
(660) 665-1922

Physical Address
1815 E HAMILTON ST
KIRKSVILLE
MO 63501-3903

Owner
THE ADAIR COUNTY FAMILY YMCA, INC.

Mailing Address
1708 S JAMISON ST
KIRKSVILLE
MO 63501

Provider/Director
SPARKS, JAMIE

E-mail Address
krouner@adairymca.org

Incorporated
Incorporated

Child Care Specialist
BETHANY CARREL DUCKWORTH

Age Range
5 YEARS - 9 YEARS

Capacity
100

Facility Type
SCHOOL AGE

Limitations

Inspection Information

Date
10/02/2023

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2455853539

Document	Document-Date
APPLICATION	05/20/2021
ARTICLES OF INCORPORATION	08/04/2021
CERTIFICATE OF GOOD STANDING	08/04/2021
CERTIFICATE OF INCORPORATION	08/04/2021
CHILD CARE PRACTICES	08/04/2021
DAILY SCHEDULE	08/04/2021
DIRECTOR'S JOB RESPONSIBILITIES	08/04/2021
DIRECTOR'S QUALIFICATIONS	05/14/2021
DISCIPLINE POLICIES	08/04/2021
DISASTER AND EMERGENCY PREPAREDNESS PLAN	08/04/2021
EQUIPMENT LIST	07/28/2023
JOB RESPONSIBILITIES	08/04/2021
LINES OF ADMINISTRATIVE AUTHORITY	08/04/2021
POLICIES	08/04/2021
SAMPLE FORMS	08/04/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	07/28/2023
SAMPLE WEEKLY MENU	08/04/2021
LICENSING ORIENTATION	05/17/2021
ANNUAL DECLARATION	07/28/2023

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.