Child Care Link

Child Care Link



Name:

Mailing Address:

City: State: Zip:

Search Area:
(Such as a work or home address)

Phone: Fax: Fax Referrals : Yes No

Email: Employer:

Child's First Name: Age of child:  or Birth date   

Type of care needed:
Child Care Center Family Child Care Home Camp Head Start
Preschool (partial day) School Age Program Play Group
Parent/Child Day Out Respite Care After School/ Tutoring/Mentoring Program

Day/Days of week care is needed:

Monday

 Wednesday Friday Sunday
Tuesday Thursday Saturday

Hours care needs to start:
Hours care needs to end:

Parent(s) Age:
Relation to Child:

Reason for seeking childcare:


Income category (per year):
Under $10, 000 $10,000-$29,000 $30,000-$39,000 $40,000 & up

Does your child have health insurance? Yes No

The Council of Community Services in Roanoke Virginia

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ADDITIONAL PROGRAMS:

Child Care Link

Search Council of Community Services

Child Care Link
502 Campbell Ave.
Roanoke, VA 24016
(540) 985-0131 ext. 300
Fax: 982-2935

Council of Community Services
P.O. Box 598 24004
502 Campbell Ave. SW
Roanoke, VA 24016

Office: 540.985.0131
Fax: 540.982.2935
CCS Toll-Free: 800.354.3388

2-1-1 VIRGINIA
Information & Referral:
Call 2-1-1

info@councilof communityservices.org

© Council of Community Services 2007
All Rights Reserved