Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Request for Child Care Referral ListÂ
A listing of registered and licensed child care facilities will be emailed to you upon completing this form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Full Name (first and last)
*
Your answer
Your email address
*
Your answer
Your phone number
Your answer
What area are you looking for child care in?
100 Mile House area
Bella Coola area
Williams Lake
Clear selection
What age is the child/children you are seeking child care for?
Your answer
What type of child care are you looking for?
Full time, Monday to Friday
Part Time
Before school
After school
After hours (evenings or weekends)
Clear selection
Would you like information on opening a child care center in your home?
Yes
Clear selection
Other comments or questions.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
