CCA-1291A EMPOWER.PDF

Maricopa County — Formal (2023-01-25)

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Department of Health Services LogoA kid with an apple in hand and a word Empower
EMPOWER PROGRAM
OVERVIEW & ACKNOWLEDGEMENTS:
EMPOWER
The owner or individual listed below has registered and is a participant with the EMPOWER Program 
accessible on the ADHS website at:
https://azdhs.gov/prevention/nutrition-physical-activity/empower/index.php
D.E.E.P
The owner or individual listed below is responsible for writing and updating the Emergency 
Preparedness Plan and has completed/passed the Disaster Emergency Evacuation Preparedness 
(D.E.E.P) online training accessible on the ADHS website at:
https://www.azdhs.gov/documents/licensing/childcare-facilities/training/deep-online-training.pdf
Provider ID: 
  Facility Name: 
I certify that I have taken the D.E.E.P online training and that I am a member of the EMPOWER 
program accessible on the ADHS website
Date: 
  Signed: 
	
	 Name: DES logo
Equal Opportunity Employer / Program • Auxiliary aids and services are available upon request to individuals with disabilities 
• To request this document in alternative format or for further information about this policy, contact 602-542-4248; TTY/TDD 
Services: 7-1-1 • Disponible en español en línea o en la oficina local  CCA-1291A FLYENG (08-21)
	 	
	
	
	
	 	
	
	
	
                
                 	
	
	
	
	
	
	
	
	
	
	
	
	
	
	 	
	
	
	
	 	
	
	
	
           
            	 	
	
	
	
	
	
	
	
	 	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
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