-
Childcare4U Parent Application - Please fill out this application in full.
Parent Information
Mother's FULL name:
Father's FULL name:
Email Address:
Phone Number:
Home Address:
How did you hear about Childcare4u.org?
Friend or Family Member
Co-worker or Neighbor
Craigslist
Advertisement
Childcare Answers
Other
Child #1 Information
Name
Sex
Male
Female
Unknown
Current age of Child #1
Not born yet
0-3 months
3-6 months
6-9 months
9-12 months
12-16 months
16-24 months
2-3 years
3-4 years
4-5 years
5+ years
Child #2 Information
Name
Sex
Male
Female
Unknown
Current age of Child #2
Not born yet
0-3 months
3-6 months
6-9 months
9-12 months
12-16 months
16-24 months
2-3 years
3-4 years
4-5 years
5+ years
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:
146th & 37
146th & Hazel Dell
146th & Olio
141st & 37
Near Hamilton Town Center (exit 210/ I-69)
116th & Brookschool
116th & Allisonville
Castleton
Westfield
Carmel
Noblesville
86th & Oaklandon (Geist Area)
Other location, please indicate below:
I would like to interview the following types of providers:
State Licensed Providers
Unlicensed Providers
Paths to Quality Participants
CCDF Providers (Childcare voucher)
Providers with over 2 years experience
Provider that provide a curriculum
ALL types of providers
Other location description:
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 daycare environment that is...
To help us better serve you, please answer the questions below.
What are your primary concerns when selecting a childcare home? Please check the areas that MOST concern you:
Ratio (Teacher:Student)
Weekly Tuition
Credentials/Certifications of Caregiver
Type of services provided (example: curriculum)
Food provided (ex: Organic/non-organic)
Inspection History
Community Involvement by the caregiver
Number of years in business
Number of children in your child's age group
Backyard and Indoor amenities
Cleanliness/Safety of the Environment
Hours of Operation
Proximity to home or work (Location)
Square footage available for daycare use
Daily Schedule (for children)
Communication (ex: daily sheets)
Daycare Closure/Vacation Policy/Sick Policy
Contract requirements
Please choose the best answer/answers to complete this sentence: I am searching for childcare because
I am unhappy with our current situation.
we have had a horrible experience.
because our current daycare is closing.
I want a better fit for my child and family.
we have recently moved to the area.
because our budget has changed.
I want to see what other options are available.
my child/ren need to be around kids their age.
because I want an educational environment.
I am expecting a child in the near future.
Other: please indicate below
If you have indicated "Other" in the above question, please elaborate:
If you would like to share any additional information, please add it here:
Additional Information:


Website Builder provided by  Vistaprint