Child Care Referral Request « Child Care Council – Rochester, NY

Child Care Referral Request

40th Anniversary Celebration is October 24th, 2012October 1 2012
Save the Date for the Child Care Council’s 40th Anniversary Celebration! Wednesday, October 24, 2012 – 6:00pm to 9:00pm at the Artisan Works. Event Schedule: 5:30—6:00 pm Child Care Council Tour 6:00—7:00 pm Hospitality Hour-Artisan Works Tour Light Appetizers, Live Music! Raffles/Silent Auction 7:00—9:00 pm Dinner and 40th Anniversary Celebration! Learn more about the Artisan [...]
The Greater Rochester Parent Leadership Training Institute announces a new course!July 17 2012
The Parent Leadership Training Institute (PLTI) is a national family civics model, with a 30-year track record in providing parents the knowledge and tools of civic engagement to expand parental involvement in local decision-making. The PLTI course will start in September 2012.

Health and Safety for Child Care CentersJanuary 1, 2012
This is not only a great training for new center staff but also a great refresher for current staff. It is a 15 hour class that covers all of the required topics. This is a competency-based curriculum which requires the successful completion of written and demonstration tests. To schedule or for more information call Ed [...]
Health and Safety For Family and Group Family ProvidersJanuary 5, 2012
This training series is required for anyone who wishes to become registered or licensed as a Family or Group Family Child Care Provider in New York State. The material is presented in six sessions and covers seven specific training modules. Existing providers will find this a great refresher course in 7 of the 9 required [...]

General Information:

The information is intended for referral purposes only. We do not warrant the information concerning any provider, nor do we license, endorse or recommend any particular provider. Only you can determine whether the quality of care is appropriate for your child.

All information entered on this form is confidential.

If you do not receive information within two business days, please resubmit or call (585) 654-4720.

For more information concerning any program that may be of interest, please visit ocfs.state.ny.us or call the Office of Children and Family Services at (585) 238-8531.

Fields marked with an * are required in order to process your referral.
For the most accurate referrals, all fields must be completed.

Name of Person Needing Child Care Referral

First Name*
Last Name*
Street Address*
Unit Number
City*
State*
Zip Code*
Mailing address, if different

Contact Information

Please provide at least one contact number. Phone numbers should include area code.
Work Phone
Home Phone
Email Address*
Cellular Phone

Statistics of Person Requesting Child Care Referral

Age*
Relationship to Children*
Family Size*
Employment Status*
Adults in Household*
Have you used our service before?*
A parent or guardian is a member of the:
Army Marine Corps Navy Air Force
A Referral Specialist will contact you with information on military fee assistance programs you might be eligible for. An enhanced referral service is available for Army and Marine Corps families.
A Child Care Consultant will contact you to determine eligibility for an enhanced referral service and fee assistance through the National Association of Child Care Resource & Referral Agencies and the Department of Defense.
You may be eligible to receive assistance paying for child care if your household income is:
Income Category*
I would like information on financial assistance in my county.*
Monroe, Wayne, and Livingston Counties have different financial assistance programs and different income ranges, some up to or above these numbers.
*

Status for County Child Care Subsidy

Eligible for County Child Care Subsidy
Receiving County Child Care Subsidy On Waiting List for County Child Care Subsidy Not Eligible for County Child Care Subsidy Not Receiving County Child Care Subsidy Protective/Preventive/Foster Care

Reason you are seeking child care or a change in child care:

Child One General Information

First Name
Last Name
Gender
Birthdate*
Date Child Care Needed
Hours Child Care Needed (ex. "7am to 4pm")*
School District
Care Needed
Year Schedule
Days Care Is Needed
Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Type of Child Care Desired

Environmental Preferences

Smoke Free No Pets Smoking-No Preference Pets-No Preference
Please identify any pet/food allergies

Languages Needed

English Spanish American Sign Language Other
If other please specify which language(s)

Special Needs*

*In order to better serve you, please explain in the comment field below

Additional Comments

If you have additional comments that would be helpful in processing your referral request, please use the space below. You may also use this space to add additional children. Please include date of birth and any special needs.

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