Palm Beach Provider Portal

CREATE ACCOUNT

Username (email)

Re-enter Username

Free email address are available through Yahoo or Google

Password

Re-enter Password

The following information will be used to verify your Provider status.

Provider Id

Provider Extension

Attestation: The undersigned represents and warrants that he/she has full and complete authority to access and submit information on behalf of the entity listed below.

Name of the Child Care Business

Title

First Name

Last Name

Phone Number

Email Address to be used for Communications by the Coalition

Enter a Security Question and Answer to be used in case of Password Reset.

Security Question (Create your Own)

Security Question Answer

Do not register again if you have previously used the site. Use the reset password link in the Login panel if you need to reset your password!

LOGIN

CREATE ACCOUNT