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.
Email address *
Date: *
MM
/
DD
/
YYYY
School Year: *
Your answer
Child's Name: *
Your answer
Grade: *
School: *
Your answer
Morning / Afternoon / Both *
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 *
By checking the box below, you acknowledge the request *
Required
A copy of your responses will be emailed to the address you provided.
Submit
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