Childcare Inquiry Form

Childcare Inquiry Form

Thank you for considering Willocks Care Co. We're committed to connecting families with trusted, dependable caregivers. Please complete the form below so we can learn more about your childcare needs and begin the matching process.
Parent/Guardian Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
What type of care are you looking for?
Number of Children
Children's Names and Ages
Do any children have allergies, medical concerns, or special needs we should be aware of?
If yes, explain
Additional responsibilities
What qualities are most important in your ideal caregiver? Check all that apply:
Preferred time - Monday (Start)
Preferred time - Monday (End)
Preferred time - Tuesday (Start)
Preferred time - Tuesday (End)
Preferred time - Wednesday (Start)
Preferred time - Wednesday (End)
Preferred time - Thursday (Start)
Preferred time - Thursday (End)
Preferred time - Friday (Start)
Preferred time - Friday (End)
Preferred time - Saturday (Start)
Preferred time - Saturday (End)
Preferred time - Sunday (Start)
Preferred time - Sunday (End)
Special Instructions or Requirements
If yes, please explain.
What is your biggest childcare challenge right now?
How did you hear about Willocks Care Co.?
By submitting this inquiry, I understand that Willocks Care Co. will use the information provided to help identify and recommend potential childcare candidates. Submission of this form does not guarantee placement.
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