Critical Care for Eligible Children
Executive order 20-82 indicates that a school district that is operating a hybrid or distance learning model must provide school-aged care (grades K-6) for eligible children at no cost during the time those children are not receiving instruction during the regular school hours (8am-3pm). During hybrid 5th and 6th graders will remain in their classroom

Eligible children are children whose parents work in the following fields (documentation required):
Healthcare and public health
Law enforcement, public safety and first responders
Food and Agriculture
Judicial Branch (essential services)
National Guard (activated under a Governor Executive Order)
Educators and school staff providing in-person instruction or caring for children of critical care workers
Childcare and school-age care providers

*If your child is eligible and will need to attend childcare/school during the school-day, please fill out the following form. The child must attend childcare at the school district they go to.
****Rates will apply if you need care before 8am and after 3pm. This service is only available for days when children were planned to be in session not scheduled days off such as MEA break.
Email address *
Parent/Guardian 1 First and Last Name *
Parent/Guarding 2 First and Last Name
Parent/Guarding 1 Occupation (Verification Required) *
Parent/Guardian 2 Occupation
Clear selection
My child will need to attend school during hybrid or distance learning at the following times: *
Required
Child 1 First and Last Name *
Child 1 Grade Level *
Child 2 First and Last Name
Child 2 Grade Level
Clear selection
Additional Children Information( First Name, Last Name & Grade level)
Emergency Contact Information or alternate pick up person (name, relation & phone number) *
My family's child care needs vary. Please explain in detail below including if the dates and times differ from the times listed above.
Does your child have any dietary needs? *
Required
If yes, explain dietary needs.
Please list any medical or other concerns that your child(ren) have.
Parent Contact Information (Parent 1 and Parent 2 phone numbers)
Anything else that we need to know to provide care to your child(ren).
Submit
Never submit passwords through Google Forms.
This form was created inside of Holdingford Public Schools. Report Abuse