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Child Care Request Employee Benefit Form

Please complete this confidential request form to receive customized referrals from a child care specialists:

Child Care Employee Benefit

This field is for validation purposes and should be left unchanged.
Thank you for giving us the opportunity to assist in your child care search. The information you provide below will be forwarded to a child care specialist at the child care resource and referral agency that serves your location. There is no cost to you for these services.
Please choose one of the following:(Required)
How would you like to receive your child care referrals?(Required)
Our goal is to send out referrals within one business day. You may need to check your spam or junk mail because often our emails are not filtered properly. Contact us if you do not receive an email from us within one business day.
Name(Required)
Address(Required)
Have you served in the military?(Required)
Are you employed?(Required)
Is your spouse/partner employed?(Required)
Are you currently receiving public child care subsidy?(Required)

CHILD 1

Gender(Required)
Day Care Needed
Drop Off Time
Pick Up Time
Monday-Friday
Saturday
Sunday
Desired Location of Care(Required)

CHILD 2

Gender
Day Care Needed
Drop Off Time
Pick Up Time
Monday-Friday
Saturday
Sunday
Desired Location of Care

If you have other questions or concerns, contact the coordinator of these services: Nicole Masucci, Director of Family & Employer Services at the Child Care Council of Westchester at (914) 761-3456, ext. 139, or nicolem@cccwny.org.

Disclaimer: The names are intended as referral options only and not recommendations. The information about the child care providers on our database is supplied by the providers themselves and has not been verified by the Council. The Council does not recommend any particular provider nor can we guarantee a provider’s capabilities or the quality of care. Therefore, inclusion on the database should not be seen as an endorsement of nor recommendation by the Council. Since selecting a provider is a subjective decision, you should visit several providers to determine which is best for your family and decide for yourself if any fulfill your needs.