EmailMeForm
SUMMER DAY CARE INTEREST FORM
Child's Name
*
First
Last
Age
Parent's Name
*
First
Last
Person completing the survey
Family Address
*
Email
*
Phone
*
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Are you classified as an essential worker? Who do you work for?
*
Do you need state funding to attend?
*
Yes
No
Have you applied for funding yet?
*
Yes
No
When do you need care to start?
*
How long do you need care?
*
Can you commit to a full month?
*
Do you need care 5 days a week?
*
Yes
Other
What hours during the day do you need care?
*
Would you consider remaining with us during the school year if regular child care options are not availabe?
*
Funding will go through June 30th but I assume they will extend as needed. Please answer this as if camps are closed.
Any added thoughts, concerns. We welcome your feedback as always.
