Care Form
Please fill out this form to continue the process of securing your child care services with Little Star Care for.After you fill out this form, we will contact your family with more details about our availability, pricing, plan, and safety procedures.  Please contact us at Care.LittleStar@gmail.com for more information.
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Email *
Desired Start Date
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What type of child care services are you seeking? *
Required
Preferred Method of Contact *
Full Name *
Home Address *
Contact Number *
Parent's Occupation or Employment Status? *
Parents Highest Level of Education *
Family Annual Income *
Seeking an hourly or salary employee? *
Seeking a child care contract of ...? *
Child's Date of Birth *
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DD
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Child's Last Name *
Child's First Name *
How many hours of care are you seeking? *
Monthly Child Care Budget *
Child's care Type *
Anticipated Child Care Schedule *
Required
Desired hours of care? *
Why are you looking for child care at this time? *
My childcare needs are ... (i.e. language, social emotional development, behavior, independence) *
My families wants to learn more about...? *
Important comments, questions, or health information. *
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