Request Child Care Listing

This is not an application for help paying for child care.
To apply for School Readiness financial assistance, click here

Select your county. *SelectOrange County

Is this your first time using our services? *

• Yes
• No

Do you currently receive School Readiness funding? *

• Yes
• No

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Email *

Main phone *

Other phone

Relationship to child *Click to selectParent/step-parentTeen parentFoster parentLegal custodianRelativeRefuse to shareOther

Primary family language *

Primary child care issue *Click to selectAffordability/CostCare endingCurriculum/ProgramLocation/TransportationNo openingsQualityScheduleSpecial needsType of carePrefer not to shareNone

First child *

First

Last

Date of birth *

MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Gender *

• Male
• Female

Special needs:

Days child care needed *

• Monday
• Tuesday
• Wednesday
• Thursday
• Friday
• Saturday
• Sunday

Time from *

Time to *

WOULD YOU LIKE TO ADD A SECOND CHILD?

• Yes
• No

Second child

First

Last

Date of birth (C2)

MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Gender (C2)

• Male
• Female

Special needs (C2):

Days child care needed (C2)

• Monday
• Tuesday
• Wednesday
• Thursday
• Friday
• Saturday
• Sunday

Time from (C2)

Time to (C2)

WOULD YOU LIKE TO ADD A THIRD CHILD?

• Yes
• No

Third child (C3)

First

Last

Date of birth (C3)

MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Gender (C3)

• Male
• Female

Special needs: (C3)

Days child care needed (C3)

• Monday
• Tuesday
• Wednesday
• Thursday
• Friday
• Saturday
• Sunday

Time from (C3)

Time to (C3)

Type of child care preferred *

• Child Care Center
• Family Child Care Home
• Gold Seal Provider
• VPK
• Large Family Child Care Home
• Licensed Exempt Provider
• Private School

Please select the type of child care provider listings you prefer

Zip codes from which you would like to receive child care listings *

How would you like to receive child care listings? *Click to selectEmailPhonePostal mail

How did you hear about Child Care Resource & Referral services?

• Rumba 100.3 FM
• Magic 107.7
• Mega 97.1 FM
• The Beat 104.5 FM
• Orlando Sentinel
• Telemundo Orlando
• Univisión Orlando
• LYNX Buses
• Facebook
• Instagram
• Billboard
• Other (please fill in below)

–> Other

Special requests or comments such as other languages, curriculum or maximum price desired:

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