Essential Worker Child Care Survey
Health care workers and first responders, as well as other essential workers, are important to our community's response to the COVID-19 crisis. As such, we are committed to supporting all community-wide efforts that maintain the regular reporting of those employees to work. Please complete the following survey as we work to connect essential workers to available child care programs.
 
1.
What type of emergency worker are you?
Physician/physician assistant
Nurse/nurse assistant
Hospital personnel
Paramedic/EMT
Firefighter
Police officer
Essential government worker
Grocery/pharmacy staff
Child care worker
Food service worker
Other  
2.

Please write the times/shifts you need care.

 

50 characters left.
3.

Do you need help finding child care?

Yes
No
4.

 

Do you have a child with special needs that requires child care? 


Yes
No
5.

If  you need helping finding care, please provide your phone number and the age(s) of your child(ren):

 

1000 characters left.
6.
If you need help finding child care, please provide your contact information.

First Name:
Last Name:
Company Name:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

Child Care Resource Network will reach out to you to help you access child care as quickly as possible. We are working diligently with the child care community to be able to link parents to child care programs with the capacity to quickly enroll new families. If you have any questions, please contact us at (716) 877-6666 ext. 3064.