Intake (Forms)

Licensed Child Care Intake forms

​​Child Care Service Intake Form

Licensed Home Child Care Intake Form (to completed by home child care supervisor or consultants/advisors

NOTE: If there is more than one individual/agency to contact, you will be asked to fill out an Authorization for Release of Information form for each source as we need to send the form with your original signature on it.
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To fill out a form, you can download it on your computer and complete it by using Adobe Reader by clicking on the name of the form. Forms are identified with the **. Once the form has been completed, you can save it or print it and then send it to us via e-mail. Click here to download Adobe Reader for free.