Home | Help for Families | Services for Providers | QRIS (Quality Rating Improvement System) | Contact Us Child Care Switchboard Child Care Referrals: Referral Request Form First Name Last Name Relationship to child needing care Email Address Mailing Address: Street City, State, Zip Code If you want child care at another location (employment, school, etc.), enter other location here. Reason for needing child care Employment Training Looking for work Sick Care Child's Needs Parent's needs Special needs of child Alternate care Dissatisfied with current care CPS/respite Job/schedule change Job travel Extended work hours Other Daytime phone Best time for us to call between 8am and 5pm Do you have a program to help you pay for child care? Birthdates of children needing child care (mo/day/yr) Days of the week child(ren) need care Hours child(ren) need care Does your child need transportation to/from school? School Name Type of care preferred Child care center Family child care home No preference Comments The CDRC Child Care Switchboard provides referrals only - NOT recommendations. It is the parents responsibility to screen potential providers.