Join Our Family

Kids Only 3 - Jefferson

Thank you for your interest in our high quality childcare program. Please give us some basic information about you and your family, and we will contact you if spots become available.

(If registering two or more children, a separate form must be filled out for each child)

Parent Name

Child Name

Phone

Child's Date of Birth

Do you qualify for ODJFS childcare assistance?

Yes

I don't know

** Visit http://jfs.ohio.gov/cdc/docs/ChildCareApplicationJobAid.stm for more information.

Will you attend a Full Time schedule or Part Time schedule?

Full Time (25 hours or more per week)

Part Time (24 hours or less per week)

Unsure

** A schedule is considered "Full Time" if it exceeds 25 hours per week.

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