First Responder Childcare: School-Age Children
On March 14, 2020, Governor Hogan enacted an emergency order to expand child care access to child care for critical personnel during the state of emergency. This will help ensure that child care services are available for providers of health care, emergency medical services, and law enforcement personnel while schools are closed to prevent the spread of COVID-19.

Rock Church Academy Childcare Center is accepting childcare applications for critical personnel (stated above). All critical personnel must provide photo identification verifying that they are indeed employed in a critical area and in need of temporary childcare while school is not in session. Childcare will be offered on a weekly basis during this current state of emergency.

Our center will keep attendance sheets and have parents sign-off weekly. MSDE will be sending information on the process for reimbursement for tuition for parents and providers as this crisis continues.

All critical personnel must also provide a copy/picture of their badge with their photo on their badge and a
driver’s license if the badge does not have a picture. This identification will be used to prove they are essential personnel. Per MSDE, all emergency workers will have a badge.

For the safety of all children, staff, and families, our center maintains the highest level of health and wellness policy implementation and standards of sanitation and cleanliness. Children who are ill, symptomatic, or who have been around those who are ill will not be admitted for care during this time.
Sign in to Google to save your progress. Learn more
Child's Full Name *
Mom's Name *
Dad's Name *
Best Phone Number *
Best Email Address *
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Current Grade Level *
Required
Type of Care Needed *
Required
Childcare Liability Statement
By typing below, I affirm that my typed name serves as my official electronic signature. I affirm that I am the legal parent/guardian of the child listed on this electronic form. I understand that I am enrolling for temporary childcare for critical personnel during the current state of emergency in the state of Maryland. I authorize Rock Church Academy and its’ representatives to administer First Aid and/or take my child to a medical facility for treatment if needed.  I understand that I am responsible for any medical or dental costs not covered by my insurance.  I acknowledge the risk of physical injury to my child associated with participation in any and all activities at Rock Church Academy, or wherever they may take place both on or off-campus. I accept personal financial responsibility for any bodily or personal injury sustained or associated with any and all activities at/or sponsored by Rock Church Academy. Further, I agree to hold harmless Rock Church Academy and its’ representatives for injury related to or sustained during all activities at Rock Church Academy. I understand that Rock Church Academy has a No-Refund Policy. Refunds will not be issued for any reason, including dismissal for behavioral concerns. I understand that I am solely responsible for any and all legal fees and other fees arising from legal proceedings that I may pursue against Rock Church Academy or its’ representatives. Lastly, I understand that my child’s photograph may be used for promotional endeavors including but not limited to: magazines, brochures, flyers, web publications, and media presentations.
Parent's Electronic Signature *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms