Form

You've come to the right place! At Child Care Associates, we are here to help your family find the quality early education and care you need.
Forma de interes para el condado de Tarrant. En Child Care Associates, estamos aquí para ayudar a su familia a encontrar la educación y el cuidado tempranos de calidad que necesita.

Check here if you are a Community Partner completing this form for a parent or guardian.
Marque aquí si es un socio comunitario y completa este formulario para un padre o tutor.

Provide the following Parent/Guardian information:
Proporcione la siguiente información del padre/tutor:

First Name of Parent/Guardian*

Primer Nombre de Padre/Madre o Tutor

Last name of Parent/Guardian*

Apellido de Padre/Madre o Tutor

Street address*

Dirección

City*

Ciudad

State/Region*

Estado

Postal Code*

Código Postal

Phone number*

Número de teléfono

Email*

Correo electrónico

Parent's/Guardian's Primary Spoken Language*

Idioma principal hablado por los padres/tutores

Which languages are used at home? (Select all that apply)*

¿Qué idiomas se utilizan en casa? (Seleccione todas las que correspondan)

Provide the following information for the child(ren) you're interested in enrolling:
Proporcione la siguiente información para el niño (niños) que desea inscribir:

Select the Age(s) for Child(ren) You Wish To Enroll. Select all that apply.*

Seleccione las edades de los niños que desea inscribir. Seleccione todo lo que corresponda.

Child #1 DOB (or due date if expecting)*

Fecha de nacimiento del niño/a #1 ((o fecha de parto si estás esperando)

Month/Day/Year

Child #1 Full Name (type "Expecting" if applicable)*

Nombre completo del niño/a #1

Child #2 DOB (or due date if expecting)

Fecha de nacimiento del niño/a #2 (o fecha de parto si estás esperando)

Month/Day/Year

Child #2 Full Name (type "Expecting" if applicable)

Nombre completo del niño/a #2

Check here if you need to add additional children. If you are seeking services for more than 4 children, please mention this to our team member when you are contacted. Marque aquí si necesita agregar niños adicionales. Si está buscando servicios para más de 4 niños, menciónelo a un miembro de nuestro equipo cuando lo contacten.

About Our Child Care Studios

Child Care Associates offers a full-day educational program with the option of before and after care. To view our Child Care Studio locations, and hours offered at each specific Studio, please see Map.

Sobre Nuestros Estudios de Cuidado Infantil
Child Care Associates ofrece un programa educativo de día completo con la opción de cuidado antes y después. Para ver las ubicaciones de nuestros estudios de cuidado infantil y los horarios ofrecidos en cada estudio específico, consulte este mapa.

Select your preferred center - Please see Map.*

Selecciona tu centro preferido - Por favor vea el Mapa

Select the center that would be your second choice - Please see Map

Selecciona el centro que sería tu segunda opción - Por Favor vea el Mapa.

Select the programs you are interested in (select all that apply):*

Selecciona los programas que te interesan (seleccione todas las que correspondan):

Services for expectant families (Prenatal Home visiting)

Home visiting (for infants and toddlers)

Early Head Start/Head Start

Pre-K (ages 3 yrs to 5 yrs)

Full-day program (7:45AM to 3:30PM)

Before/After School

None of the Above

Please answer the following questions:*

Child(ren) is currently in Foster Care

Currently Homeless

Child(ren) of an active-duty member of the armed forces of the United States

Parent was injured or killed during active military duty

Parent was a Star of Texas recipient

None of the Above

Number of People Living in Household*

Número de personas que viven en el hogar

Is the child(ren) a U.S. Citizen?*

Does the child(ren) have a medically diagnosed disability?*

¿Tu hijo (hijos) tiene(n) alguna discapacidad diagnosticada médicamente?

ARD or IEP or IFSP

Suspected Disability/Medical Professional Referral

No Disability

Please indicate the services currently being received (select all that apply):*

Por favor, indica los servicios del programa que actualmente están siendo recibidos:

TANF (Temporary Assistance to Needy Families)

SNAP (Supplemental Nutrition Assistance Program)

SSI (Supplemental Security Income)

CCMS (Tarrant County Child Care Management Services)

None of the above

Please indicate the following (select all that apply):*

Parent(s)/Guardian(s) employed 25-hrs or more per week (single) or 50-hrs/week (both working)

Parent(s)/Guardian(s) employed less than 25 hours per week and not enrolled in schooling

Parent(s)/Guardian(s) attending 25-hrs or more per week of school, college, training or adult charter

Household income is less than $25,000

Household income is between $25,000 and $50,000.

Household income is more than $50,000

Unemployed

Prefer not to respond

Please be sure to click the Submit button below. After submitting the form, you will receive a confirmation e-mail with next steps. Thank you.
Asegúrese de hacer clic en el botón Enviar a continuación. Después de enviar el formulario, recibirá un correo electrónico de confirmación con los siguientes pasos. Gracias.

Family Interest Form for Tarrant County