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Child Care Interest Form
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* Indicates required question
Parent Name(s):
*
Your answer
Phone number(s):
*
Your answer
Email Address:
*
Your answer
Names, Ages, and Birthdate of Child/Children:
Your answer
How did you hear about us?:
*
Your answer
Days Childcare is needed (mark all that apply):
Monday
Tuesday
Wednesday
Thursday
Friday
Will you need Child Care in the summer?
Your answer
Hours Child Care is needed:(
We are open
6:30 AM to 6 PM
no more than nine hours per day without prior approval
)
What is most important to you in an early learning program for your child?
Your answer
Date you need Child Care to start:
Your answer
Will you be using Rutgers Child Care assistance?
Your answer
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