Healthcare/Emergency Worker Childcare Request

During the statewide closure of Minnesota schools, School District 197 will provide childcare for children ages 12 and under from families of healthcare workers and other emergency providers. ("12 and under" is defined as students currently enrolled in our school district from all-day preschool participants through age 12.) This childcare is available for families of healthcare workers and other emergency providers ONLY regardless of whether they have used School District 197 School-Age Care services in the past. School-Age Care will be closed for all other families. Please note that completing this survey DOES NOT mean your child is registered for childcare. The childcare team will get in touch with you to complete the official registration process.

Question Title

* Childcare will be provided for children of the following emergency workers (as defined by the state of Minnesota). Please select all that apply for your family. You will be asked to provide employment verification.

Health care providers and systems, including hospitals and clinics

Post-acute and long-term care facilities, including nursing and assisted living facilities

Home care workers

Personal care assistants

Ambulance/emergency

Direct care and treatment

First responders

Firefighters

Personnel providing correctional services

Essential court personnel

Minnesota State Veterans Homes staff

State and local public health agency employees

MNsure Navigators

County financial/eligibility workers

County case managers

County staff in emergency management or health and human services

Other (please specify)

Question Title

* Please use the following space to provide information about each of your children who need care:
First name/last name
School
Grade

Question Title

* Please use the following space to provide the first name and last name of any of your children that have special needs and require additional accommodations.

Question Title

* Parent Contact Information

Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country

Email Address *

Phone Number *

This survey is for planning purposes only. Please watch your email for for information and directions regarding registration information.

Healthcare/Emergency Worker Childcare Request

Question Title

* Childcare will be provided for children of the following emergency workers (as defined by the state of Minnesota). Please select all that apply for your family. You will be asked to provide employment verification.

Question Title

* Please use the following space to provide information about each of your children who need care:First name/last nameSchoolGrade

Question Title

* Please use the following space to provide the first name and last name of any of your children that have special needs and require additional accommodations.

Question Title

* Parent Contact Information

* Please use the following space to provide information about each of your children who need care:
First name/last name
School
Grade