You can always press Enter⏎ to continue
Essential Worker Childcare
If you are an essential worker and need childcare from January 4-7, please fill out this form. Please note: there is no formal learning during this week.
5
Questions
START
1
What days from January 4-7 do you need childcare?
*
This field is required.
Select all that apply.
Tuesday, Jan 4
Wednesday, Jan 5
Thursday, Jan 6
Friday, Jan 7
Previous
Next
Submit
Press
Enter
2
What time on the selected days do you need childcare?
*
This field is required.
Example: Tuesday, Jan 4: 8 am-12 pm and Wednesday, Jan 5: 1-3 pm
Huge
Large
Normal
Small
Ok
Ok
Previous
Next
Submit
Press
Enter
3
What are the names of your children who need the childcare?
*
This field is required.
Previous
Next
Submit
Press
Enter
4
Your name is
*
This field is required.
First Name
Last Name
Previous
Next
Submit
Press
Enter
5
Your email is
*
This field is required.
example@example.com
Previous
Next
Submit
Press
Enter
Should be Empty:
Essential Worker Childcare
[Edit]
Question Label
1
of
5
See All
Go Back
Submit