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* 1. Please enter your name.

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* 2. Please enter a valid E-Mail address

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* 3. In what grade(s) is the child(ren) for which you are seeking childcare during the 2019-2020 school year? Please check all that apply.

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* 4. Are you willing to pay a fee to receive childcare services on Mondays?

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* 5. Would your child(ren) be in need of special services during childcare hours? If so, please provide details. 

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* 6. Would you be interested in childcare services that do not include transportation?

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* 7. Which hours best satisfy your childcare needs for Mondays in which school is not in session?

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* 8. Which, if any, food services need to be included in the childcare services? Please check all that apply

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