First Responder & Healthcare Worker & Essential Professions Childcare Request (Children Birth through Age 12)
The District is gathering information to ascertain if we have first responders or healthcare workers in our community who need assistance with childcare for students age birth-12. Please fill out the below questionnaire if you believe you meet these criteria and a representative from the school district will be in touch with you.
My family requires childcare services, as I am (we are) a first responder(s) or healthcare worker(s): *
Home Address
Your answer
Child(ren) Name(s) *
Your answer
Child(ren) School *
Required
Please complete this for all parents in the household:
Parent 1:
(Parent 1) Please share the name of your employer. *
Your answer
(Parent 1) Please share your role/title in the organization. *
Your answer
(Parent 1) Please share your phone number. *
Your answer
(Parent 1) Please share your e-mail address. *
Your answer
Parent 2:
(Parent 2) Please share the name of your employer.
Your answer
(Parent 2) Please share your role/title in the organization.
Your answer
(Parent 2) Please share your phone number.
Your answer
(Parent 2) Please share your e-mail address.
Your answer
Any additional questions/comments:
Your answer
Submit
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