Childcare Intake Form

Your First name

Your Last name

Your Email

Your Phone

Schedule and Availability

If you are look for 911 Nanny (childcare needed within the same week or day of the intake form), please call/text 301-337-7068. We need at least 3 hours in advance notice. Please note that a 911 Nanny is priced higher to accommodate the urgency.

What days and hours do you need coverage?

Child Information

How many children will we be caring for, and what are their ages?

Does your child(ren) have any allergies, medical needs, IEP/504 plans or special accommodations? Please write n/a if not applicable

What are your child(ren)’s interests, routines, or activities you’d like the Future Stars to support?

Are there any specific developmental goals (reading, potty training, homework help, etc.) you’d like the Star to work on? If so, please describe in detail the times schedule if applicable. If not, please write N/A if not applicable.

Childcare Intake Form

Schedule and Availability

Child Information

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