Home | Help for Families | Services for Providers | QRIS (Quality Rating Improvement System) | Contact Us Child Care Switchboard Child Care Referrals: Referral Request Form Parent/Guardian First Name Parent/Guardian Last Name Relationship to child needing care Email Address Street Address City, State, Zip Code If you want child care at another location (employment, school, etc.), enter other location here. Reason for needing child care Employment Training Looking for work Sick Care Child's Needs Parent's needs Special needs of child Alternate care Dissatisfied with current care CPS/respite Job/schedule change Job travel Extended work hours Other Daytime phone Who will pay for the child care? Self CalWorks Voucher Project Foster Bridge Other Birthdates of children needing child care (month/day/year) Start date child care is needed (month/day/year) Days of the week child(ren) need care (Check all that apply) Monday Tuesday Wednesday Thursday Friday Saturday Sunday Child(ren) need care: start time Child(ren) need care: end time Does your child need transportation to/from school? School Name Type of care preferred Child care center Family child care home No preference Comments The CDRC Child Care Switchboard provides referrals only - NOT recommendations. It is the parents responsibility to screen potential providers.