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Parent Information
Mother's Name
Father's Name
Email Address
Phone Number where you can be reached:
Home Address:
How did you hear about Childcare4u.org?
Friend, Co-worker, Family Member, or Neighbor
Craigslist
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Childcare Answers
Other
Child #1 Information
Name
Sex
Age (as of now)
Child #2 Information
Name
Sex
Age (as of now)
Specific Daycare Needs
Desired start date for daycare (if pregnant, please give us your best guess):
I am looking for childcare on the following days each week:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Days will vary (less than 3 days/week)
Days will vary (4 days/week)
Choose your desired locations based on the following:
146th & 37
146th & Hazel Dell
146th & Olio
141st & 37
116th & Brookschool
116th & Allisonville
Castleton
Westfield
Carmel
Noblesville
Other location, not listed above
I would like to interview the following types of providers:
State Licensed Providers
Unlicensed Providers
Paths to Quality Participants
CCDF Providers (Childcare voucher assistance)
Providers with over 2 years experience
Provider that provide a curriculum
If you wish to interview only LICENSED providers, please answer this question:
I want to interview LICENSED providers with the following:
Lower ratio program (1:5 or less)
I need a program that accepts CCDF
I want a PTQ participating provider
I want a NATIONALLY ACCREDITED provider.
So that we have a better idea of what your looking for, please finish the following statements:
I prefer a Home Daycare because....
A Home Daycare provider should...
I hope to find a provider that...
I want to see a home daycare environment that is...
If you would like to share any additional information, please add it here:
Additional Information:


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