Childcare for Health Care Professionals and First Responders
In accordance with directives from Governor Andrew Cuomo and County Executive George Latimer, our District will be providing access to childcare for children of parents/guardians in the healthcare profession or first responders in our community with children ages Pre-K through 12 years old.  All childcare will take place at the Hommocks Middle School.  Please fill out the following survey by 11:00 pm today if you believe you meet these criteria and you require childcare during the weekday between the hours of 8:00 a.m. and 6:00 p.m.. A representative from the school district will be in touch with you. In the event that you believe you meet these criteria and are unable to complete this form, please contact 914-220-3041.
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Home Address *
Child Name and Age *
Child Name and Age
Child Name and Age
Child Name and Age
Child Name and Age
Child Name and Age
Child Name and Age
Please complete this for all parents/guardians in the household:
Parent/Guardian 1 Name *
(Parent/Guardian 1) Please share the name of your employer. *
(Parent/Guardian 1) Please share your role/title in the organization. *
(Parent/Guardian 1) Please share your work phone number. *
(Parent/Guardian 1) Please share your personal phone number. *
(Parent/Guardian 1) Please share your e-mail address *
(Parent/Guardian 1) Please indicate how you will verify your health care professional or first responder status below: *
Parent/Guardian 2 Name (Indicate N/A if not applicable) *
(Parent/Guardian 2) Please share the name of your employer. *
(Parent/Guardian 2) Please share your role/title in the organization. *
(Parent/Guardian 2) Please share your work phone number. *
(Parent/Guardian 2) Please share your personal phone number. *
(Parent/Guardian 2) Please share your e-mail address. *
(Parent/Guardian 2) Please indicate how you will verify your health care professional or first responder status below: *
Any additional questions/comments/special circumstances: *
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