Child Care Request Form

How do I receive my Child Care information?

The Child Care Directory & Information line can assist you to identify all child care options that may meet your needs by providing free information and a list of child care resource materials complied just for you.

We kindly request that you complete the Child Care Information Request form below and then click the SUBMIT button at the bottom ofthe form. There are questions that are required to be completed. Please note * denotes a required question.

Fields marked with a * are required

1. Contact Information

2. Child Care Requirement

Date of birth:

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If you selected `Before School` and/or `After School` above, please enter the name of the school.


3. Additional Information

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