Childcare for Emergency Reponders and Health Care Providers- Registration Form
Excell Academy will provide childcare for students currently enrolled at Excell whose parents are emergency responders and health care providers. Transportation will not be provided. Please be prepared to show proof of employment i.e. paycheck stub, work badge, etc.

Parents must register by March 17th by 12pm

Child Care Regular Hours of Operation: Monday-Friday: 8:00 am - 4:30 pm

Healthcare staff as described below:
- Health care providers and systems, including hospitals and clinics
- Post-acute and long-term care facilities, including nursing and assisted living facilities
- Home Care workers
- Personal Care Assistants
- Ambulance/emergency
- Direct Care and Treatment

Other emergency staff, including:
- First responders
- Firefighters
- Personnel providing correctional services
- Essential Court personnel
- Minnesota State Veterans Homes staff
- State and local public health agency employees
- MNsure Navigators
- County financial/eligibility workers
- County case managers
- Or any county staff in emergency management or health and human services
Parent Full Name *
Your answer
Email Address *
Your answer
Place of Employment *
Your answer
Please specify the hours of childcare needed. *
Example: 10am-2pm
Your answer
Please indicate if you have before or after care hours needs. *
Daytime Phone Number *
Your answer
Work Phone Number *
Your answer
Student FULL Name(s) *
Your answer
Grade *
Does your child have any health conditions *
Your answer
Does your child take any medications at school? *
Your answer
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