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Child Care Letter
Dear Parents,
Please note: Childcare is 5 days a week. Choice of AM, PM or BOTH.
Childcare addresses must be within School District Boundaries.
A new childcare form must be filled out each school year.
You need to fill out a new form for each child.
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* Required
Email
*
Your email
Date:
*
MM
/
DD
/
YYYY
School Year:
*
Your answer
Child's Name:
*
Your answer
Grade:
*
Choose
Pre K
Kindergaten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
School:
*
Your answer
Morning / Afternoon / Both
*
Morning Only
Afternoon Only
Both Morning and Afternoon
Child's Home Address
*
Your answer
Home Phone #:
*
Your answer
Cell Phone #:
*
Your answer
Work Phone:
Your answer
Morning pick up name of child care provider:
*
Your answer
Morning pick up address:
*
Your answer
Morning pick up phone #:
*
Your answer
Afternoon drop off name of child care provider:
*
Your answer
Afternoon drop off address:
*
Your answer
Afternoon drop off phone #:
*
Your answer
Name of person completing form:
*
Your answer
Reason for Request
*
Child Care
Construction
Fire
MicV
Other:
By checking the box below, you acknowledge the request
*
I understand
Required
A copy of your responses will be emailed to the address you provided.
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