Child Care Resource and Referral
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Child Care Resource and Referral


  
Contact Information
Please complete the following form to be taken to our web based referral system. This information is used for statistical purposes only.
 

City or cities you are looking for child care in:
Birthdate(s) of child(ren): / /
  / /
  / /
Type of Care: Child Care Center
Family Child Care Home
Preschool
School-age Program
Time(s) of Day: Daytime
Evening (after 6pm)
Overnight (after midnight)
Weekends
     (Sat. and/or Sun.)
Parent/Guardian Age:
Relation to Child:
Employment Status:
Yearly Household Income: $
Family Size:
Adults in Household:
Referred By:
Phone Book
Subsidy Unit
Friend/Relative
Previous User
Provider 		Employer
Targeted Advertising
Agency
Internet Site
Reason for Seeking:
New Child
Work Related
Dissatisfied
Training/Education
Parent Needs 		Current Care Closing
Relocation
Child Needs
Other
Race or Ethnicity:

Optional

Name:
Address:
City:
State:
Zip:
Home Phone: xxx-xxx-xxxx

Please remember to return after your search and complete the Follow-up Form.
Lend a Helping Hand
CCR&R of Northeast Iowa
Exceptional Persons, Inc.
3675 University Avenue
Waterloo, IA 50701

Ph: (800) 475-0804
E-mail: childcare@episervice.org