This study assessed whether physical activity and screen-time policies in child-care centers were associated with physical activity and screen-time practices and preschool children’s physical activity. Data were collected from a sample of 50 child-care centers in North Carolina. Center directors completed a survey to assess center-level policies around physical activity and screen time. Research assistants observed physical activity and screen-time practices in each center. Children wore accelerometers to provide an objective measure of physical activity. The presence of written physical activity and screen-time policies varied considerably among centers. The average amount of play time provided to children across centers was 82.7 minutes per day. All but one center limited screen time to less than 30 minutes per day. Accelerometer data showed that children spent an average of 39 minutes per day in moderate to vigorous physical activity and 206 minutes per day in sedentary activity. Policies about staff supervision of media use were associated with stricter limits on screen time. Contrary to expectation, policies about physical activity were associated with less time in physical activity.