Vermont In Home Emergency Child Care

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This form collects information from people interested in providing in home child care for the workforce in Vermont.

Thank you for your interest in helping Vermont’s Workforce so they can do the work that we depend on. Please answer the following questions so that we can best connect you with a parent and their family.

For reference in completing this form, here is a link to the most recent guidelines.

https://www.healthvermont.gov/sites/default/files/documents/pdf/HealthGuidanceforEmergencyProgramsProvidingChildcareforEssentialPersons.pdf

What is your Name *

What Vermont town do you live in currently? If you do not live in Vermont currently put N/A. *

In what county is that?

Are you 18 years of age or older? *

Yes

Which of the following best describes your background? *

Early Childhood field

Medical field

K-12 education field

Other:

To be eligible to care for children of essential personnel, you have be certified in First Aid and have passed a background check in Vermont. Which of the following is true? *

I have had a background check by the state of Vermont and I am certified in First Aid (Essential Workers may ask you for verification)

I have had a background check by the state of Vermont BUT I am not yet certified in First Aid (we may be able to connect you with First Aid resources)

I am certified in First Aid and I have NOT had a state background check in Vermont, but I am willing to get a background check if a parent requires one.

I have neither had a state background check nor had First Aid but I am willing to get a background check if a parent requests one.

Other:

Please let us know which you would be willing to do for the family you are providing care for. *

Child care for young children (not yet in school) at the essential person’s home

Child care for school age children at the essential person’s home

Child care for a mixed age group of children

Remote support for this Emergency Care system (especially if not residing in Vermont at this time, not fingerprinted or haven't taken First Aid)

Other:

Required

Please indicate whether you would want to do this as a volunteer or as paid employment?

Volunteer only

Paid employment only

Either, depending on circumstances

Clear selection

In the interest of keeping everyone safe and healthy, are you or anyone in your household in the following categories? *

65 years of age or older?

Serious underlying condition, like heart disease, diabetes, lung disease, immune disorders or immunocompromised

Pregnant women

People with HIV

None of the above

Required

Which of the following best describes your recent behavior? *

I and all in my household have followed the social distancing rules carefully, with little contact with others outside our household and none closer than 6 feet for at least 2 weeks

I have followed the social distancing rules for at least 2 weeks, but I am not sure about others in my household

I have followed most of the social distancing rules, but have occasionally interacted with others outside my household

I have followed the social distancing rules, but for less than 2 weeks

Other:

Please tell us a little about when you are available to help essential personnel? This information is just for planning purposes, it is not a commitment to work. (check all that apply)

Weekdays, 9-5

Weekend days

Weekday evenings but not overnight

Weekday nights, sleeping over

Weekend evenings

Weekend nights

Just tell me what you need and I can be there

Other:

When childcare centers begin opening up and accepting more children in the coming months, there may be a need for additional summer-time paid positions.Are you available to work in an existing childcare center in need of additional help?

Yes

Clear selection

If you answered "yes" to the above question, where would you be able to travel to work?

Within my county

Outside of my county

Other:

Lastly, when do you anticipate being available to help with childcare?

May

June

July

August

The information you provide through this form will be shared with possible matches for their consideration. Essential Workers seeking help may contact you directly if your skills and availability match their needs. Any and all obligation, accountability, and/or liability exists solely between you and the Essential Worker who retains your services.

What is your phone number that is best to reach you?

What is your email address?

Your health and safety and that of our essential workers and families is important. Please check the box below to certify that you have read all of the information in this form and that you have been truthful and accurate in all of your responses. *

I certify that I have read and understand all of the information in this form and that all information provided in this form is true and accurate to the best of my knowledge.

Required

Thank you for your interest in supporting Vermont's essential workforce and their families.

Submit

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