Schools: Name of School District you reside in Name of nearest Public Elementary School Transportation (check all that apply): I transport children to these elementary schools/preschools I live within 4 blocks of these elementary schools I live within 1 block of a public bus route I live on a school bus route (list schools) Languages: Does anyone in your program speak another language fluently? Yes No Language(s) Does anyone in your program use Sign Language fluently? Yes No Other Services (check all that apply): Flexible Opening Hours Crisis Care Flexible Closing Hours Sick Care Advance Phone Calls Child Care Provided: Shift General Information: Hours of Operation I wish to care for (Check One): Days Open Close Monday Full Time (Over 28 hrs/wk) Part Time (Less than 28 hrs/wk) Tuesday Both Wednesday Thursday I provide care (Check One): Friday Full Year Saturday School Year Sunday Summer Only Check All that Apply: I’m willing to provide Drop-In Care I provide after school care I’m willing to provide temporary/emergency care I can accommodate rotating schedules I provide before school care I’m open on legal holidays
Schools: Name of School District you reside in Name of nearest Public Elementary School Transportation (check all that apply): I transport children to these elementary schools/preschools I live within 4 blocks of these elementary schools I live within 1 block of a public bus route I live on a school bus route (list schools) Languages: Does anyone in your program speak another language fluently? Yes No Language(s) Does anyone in your program use Sign Language fluently? Yes No Other Services (check all that apply): Flexible Opening Hours Flexible Closing Hours Advance Phone Calls Crisis Care Sick Care Child Care Provided: Hours of Operation Days Open Close Monday Tuesday Wednesday Thursday Friday Saturday Sunday Shift General Information: I wish to care for (Check One): Full Time (Over 28 hrs/wk) Part Time (Less than 28 hrs/wk) Both I provide care (Check One): Full Year School Year Summer Only Check All that Apply: I’m willing to provide Drop-In Care I’m willing to provide temporary/emergency care I provide before school care I provide after school care I can accommodate rotating schedules I’m open on legal holidays