SWRCSD Daycare Survey for Medical Professionals and Emergency Service Providers

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

The District is working to develop a plan, under an executive order from Governor Cuomo, for daycare for the children of healthcare professionals and first reponders. Please complete the survey if either parent/guardian in your home falls into one of the above categories and you need daycare.

Please select all that apply below:

A parent in the household is a medical worker

A parent in the household is an emergency service provider

I require daycare assistance.

Yes

Maybe

Clear selection

I need daycare for this many children ages 5-12.

Other:

Clear selection

I need daycare for this many children ages 13 and above.

Clear selection

My name is:

My phone number is:

My email is:

My children's names age 5-12 that need daycare are:

My children's names age 13-18 are:

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Shoreham Wading River CSD. Report Abuse

Forms