Livingston County - Child Care (4C) Council

Livingston County - Child Care (4C) Council

You may use our web form to easily request child care referral information from us. Please fill out the form below, filling in all relevant information. If more than one choice applies to a particular question, please select all that apply to your situation.

Based on the information you provide our database will compile a list of providers that match your families current needs. The more detailed information you provide the more specific your list can be. Please request any additional information you may need to help you with your child care search.

If you have any questions or would prefer to speak to us directly regarding referrals, feel free to call us at (517) 548-9112 or e-mail us at info@childcare4c.com

General Information

Parent/Guardian Name

Mailing Address

City, State, ZIP

Home Phone Number

Work Phone Number

E-Mail Address

Fax Number

Employer of Parent/Guardian

Employer of Spouse

Child Name / Expecting

Birth Date(s) / Due Date

Your Name
(if different than parent)

Your Mailing Address
(if different than parent)

Your City, State, ZIP
(if different than parent)

Search Criteria

Cities or ZIP Codes to Search
(enter up to 3 cities or ZIP codes)

Type of Care

Center
Day Care Home
Family/Group

Start Date of Child Care

Days Care is Needed

Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Time Care is Needed

From To

Type of Schedule

Full Time
Part Time
Both

Year Schedule

Full Year
School Year
Summer Only

Special Schedule

After School
Before School
Drop In
Temporary
24 Hour
Emergency

Special Program

Montessori
Religious
Co-op
Before/After Kindergarten
Kindergarten
Public School
Free Preschool/Head Start
Church or Synagogue

School Location / Name of Elementary School

Special Services

Bilingual
Special Needs Experience

Subsidy

Is Family Independence Agency helping to pay for care?

Yes
No

FIA offers a program to assist low to moderate income families pay for child care. Eligibility is based on family size and monthly income. To qualify, the gross monthly income must be below the amounts listed below.

Family Size	Monthly Income
2	$1,758
3	$2,172
4	$2,586
5	$3,000
6	$3,414
7	$3,828

Would you like FIA application mailed to you?

Yes
No

Would you like to receive information about MI Child Health Insurance?

Yes
No

How were you referred to us?

Relative/Friend
Child Care Provider
Agency/School
Internet/Media
Phone Book
Employer
FIA

Reason for Care

What is your reason for needing child care?

Employment
Relocation
School/Work First
Dissatisfied
Child Needs
Parent Needs

How would you like us to send your information?

Mail
Fax
E-Mail

(Please provide your email address if you wish to receive information by email.)

Additional Comments

We pride ourselves on our personal and professional customer service. WE will continue to work with you until you are satisfied and have a thorough knowledge and understanding of child care options, quality indicators and potential providers that meet your current needs. Please dont' hesitate to contact us again to help you with this task. Child care is vitally important to health and safety of our children.

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A proud member agency of: The Michigan 4C Association, The National Association of Child Care Resource and Referral Agencies (NACCRRA) and the United Way of Livingston County