Child Care Need Survey
Hoosick Falls Central School District will begin a Child Care Program for students in kindergarten through 6th grade beginning Monday, March 23. Please complete the survey below to indicate the need for child care if you or your spouse/partner are a health care worker, first responder or work in another one of the critical professions or occupations listed below:
Please indicate whether you or your spouse / partner are currently employed and / or volunteer as one of the following:
Essential health care workers may include licensed health professionals such as physicians, nurse practitioners, physician assistants, registered nurses, LPNs and nurse assistants or laboratory personnel.
Direct support professionals may include clinicians and support staff serving the behavioral health, intellectual/developmental disabilities and child welfare communities in residential and community-based care settings.
First responders may include paramedics, emergency medical technicians, police officers and firefighters, correctional officers or related support personnel necessary to execute those duties.
Food manufacturing, production, distribution and supply including supermarket workers and food preparation.
Transportation including commercial truck drivers of necessary supplies and equipment, transit workers, air and rail and carriers of critical and essential materials.
Construction and manufacturing including specialized equipment related to health or safety of the public.
Nonprofit and social services agencies providing support to families and employees in related fields.
Name of parent / guardian
Phone number / Contact number
Hoosick Falls Central School District
Berlin Central School District
Brittonkill Central School District
If childcare was provided from 7:00 AM to 6:00 PM, how many children do you have that you would need this service?
Ages of the children needing Child Care:
Please indicate the age of any of your children needing this service who currently have an Individualized Education Plan (IEP):
Please indicate the age of any of your children needing this service who currently have a 504 accommodation plan: (if none, type in 0)
Please indicate the age of any of your children needing this service who are currently identified as an English Language Learner: (if none, type in 0)
How often would you need this service?
Every day (Monday - Friday)
Every other day (Monday, Wednesday, Friday)
Every other day (Tuesday, Thursday)
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This form was created inside of Hoosick Falls Central School.