Child Development Resource Center

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Child Care Switchboard     Types of Child Care     Child Care Referrals     Resources    

Child Care Referrals: Referral Request Form

First Name
Last Name
Relationship to child needing care
Email Address
Mailing Address: Street
City, State, Zip Code
If you want child care at another location (employment, school, etc.), enter other location here
Reason for needing child care
Daytime phone
Best time for us to call between 8am and 5pm
Do you have a program to help you pay for child care?
Birthdates of children needing child care (mo/day/yr)
Days of the week child(ren) need care
Hours child(ren) need care
Does your child need transportation to/from school?
School Name
Type of care preferred
Comments
The CDRC Child Care Switchboard provides referrals only - NOT recommendations. It is the parents responsibility to screen potential providers.