Your Name:
Your home address:
Home Phone Number:
Your Email Address:
Please send me referrals via:
Location desired for child care
Employer
Your work address:
Work Phone Number:
Do you have an ABC voucher?
How soon do you need child care?
Birthdates of children needing care:
Days care is needed (check all that apply):
Hours care needed: from to
Type of care: (check all that apply)
Reason for needing care:
If any children are school age, name of
Is there anything else we should know about your child(ren)? For example; special needs, medical conditions, etc.
**Optional** (for statistical uses only)
How did you learn about CCR&R?
Any additional comments:
Thank you for giving us the opportunity to assist you
Important Information about CCR&R Services:
CCR&R only gives referrals and cannot recommend or guarantee a particular child care provider . We believe that parents are best able to choose and evaluate care for their children because they know their children's needs best. Since selecting a provider is a subjective decision, parents should interview several providers to determine the best choice for their child.
Individual client data is kept confidential. The information parents provide will only be used to report demographic data to our funders. Parents may be contacted by CCR&R for voluntary feedback on our services and the results of their child care searches. CCR&R does not share or sell mailing lists or client names.
Our services are completely free . CCR&R does not charge a fee for providing referrals.
We value parents' feedback . CCR&R strives to provide high quality services for all of our clients. Concerns or complaints about CCR&R services should be directed to Michael Lisle, Director of CCR&R, at mlisle@tuw.org .
We are here to help, even after a child care decision has been made. A parent who is dissatisfied with a caregiver, or who feels that the caregiver has violated a regulatory standard, may contact CCR&R to register a complaint. While we are not a regulatory agency, CCR&R takes complaints about caregivers very seriously, and will work closely with parents to help them resolve the complaints.
