Child Care | Pennsylvania State Resource Family Association

If you would like to qualify for childcare, please fill out the Child Care form below. If you have multiple children, you will have to submit the form multiple times. All children must have a separate form submitted. Children must also be fully potty trained.

Due to limited childcare, before you submit the forms, please call 1 (800) 951-5151 or email (klramper@psrfa.org) to make sure we have not reached our total capacity available. Child care will be a first come first serve basis.

Lunch and snacks will be provided. If your child has food allergies and or sensitivities please supply their lunch and snack.

Please drop your child/children off between 8:00am & 9:00am.

Thank you.

Morning Session*
Afternoon Session*
Name*
First Middle Last
Email*
Phone*
Child's Name*
Child's Age*
Please describe any accommodations your child will need to fully participate in the children’s program:
Please list any dietary restrictions your child may have:
Please list anything that would be helpful for the childcare providers to know about your child (fears, allergies, etc.):
Parental Consent - Child's Photo*
- I give my permission for my child’s photo to be taken.
Parental Consent - Emergency Medical Care*
- I give permission for my child to obtain emergency medical care.
Name
This field is for validation purposes and should be left unchanged.