Childcare Inquiry Form
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child Name
*
First Name
Last Name
Child's Age
*
Child's Birth Date
*
-
Month
-
Day
Year
Date
Which location are you inquiring about?
*
Please Select
Eastern York School District
Northeastern School District
Lincoln Charter School
York Academy Regional Charter School
York Suburban School District
YWCA York
Which Eastern York School District childcare service are you interested in?
*
Pre-K Counts
Which Northeastern School District childcare service are you interested in?
*
School Age Care
Which Lincoln Charter School childcare service are you interested in?
*
Pre-K Counts
School Age Care
Which York Academy Regional Charter School childcare service are you interested in?
*
School Age Care
Which York Suburban School District childcare service are you interested in?
*
Pre-K Counts
Pre-School
School Age Care
Which YWCA York childcare service are you interested in?
*
Early Learning Center
Pre-K Counts
School Age Care
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Pre-K Counts
Pre-K Counts is a free program for qualifying families. Please answer the questions below so we can determine eligibility.
Which Eastern School District Pre-K Counts are you interested in?
*
Canadochy Elementary
Lincoln Charter School
Which York Suburban School District Pre-K Counts are you interested in?
*
Canadochy Elementary
Lincoln Charter School
Valley View Elementary
Is your family at or below the 300% poverty level? Must answer YES to qualify. (Persons in Household: 1-$38,280, 2-$51,720, 3-$65,160, 4-$78,600, 5-$92,040, 6-$105,480, 7-$118,920, 8-$132,360, Add $4,480 for each person over 8)
*
Please Select
Yes
No
Has your child been referred to Pre-K Counts by a health/mental health practitioner?
*
Please Select
Yes
No
Is the child in foster care, kinship care, or receiving Children and Youth Services?
*
Please Select
Yes
No
You must be able to provide documentation.
Guardian has NOT obtained a high school diploma or a GED?
*
Please Select
Yes
No
Is English NOT the child's first language?
*
Please Select
Yes
No
Is the child homeless?
*
Please Select
Yes
No
Is one of the child's parents in prison?
*
Please Select
Yes
No
Is the child a migrant/seasonal student?
*
Please Select
Yes
No
Was the child's mother under the age of 18 when the child was born?
*
Please Select
Yes
No
Does the child have an active Individualized Education Plan (IEP)?
*
Please Select
Yes
No
You must be able to provide the IEP.
Does the child have a sibling enrolled in a YWCA program? If so, which program?
*
Is the child currently enrolled in a YWCA program? If so, which program?
*
The Pre-K Counts school hours are 9:00 AM until 2:00 PM. Wrap-Around Care is available at an additional cost to provide care before and/or after the school hours. Would you like more information about Wrap-Around Care?
*
Please Select
Yes
No
The Pre-K Counts school hours are 8:45 AM until 2:15 PM. Extended hours may be available. Would you need extended hours?
*
Please Select
Yes
No
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School Age Care
YWCA York supports families in York County through School Age Care programming that provides on-site before and after school care, including scheduled school days off, early dismissals, and delays.
What is the name of your child's school?
*
What is your desired start date?
*
-
Month
-
Day
Year
Date
Back
Next
Submit
How did you hear about us?
CCIS
Flyer
Family/Friend
Newspaper
Open House/Event
Social Media
YWCA York Website
Other
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