P.O. Box 446 Olympia, Washington 98507 Phone: 360.786.8907 Fax: 360.786.8960

  
 

                                  

 
 
 

 

Request Child Care Referrals

Filling out the form below will send e-mail directly to the Child Care Action Council requesting a child care search! (Searches available for Thurston, Mason and Lewis Counties in Washington State Only)

PLEASE NOTE: If you, or your spose, is employed by Thurston County, Washington State Dept of Labor & Industries or the Military only. You are eligible for Enhanced Search Services click here to complete the Enhanced Search Form.


Intake Information
What is your first and last name?
What is your home address?
What is your City?
What is your State?
What is your zip code?
What is your phone number?
Your E-mail address?
Who is your employer?
Who is your spouses employer?
What elementary school do your children attend? Or what is the closest school to your home?

Have you used our services before? 
Yes 
No 


Child Care Choices Information
 What type of child care facility are you looking for? 
Center. 
Family Child Care Home. 
Preschool Only. 

Where should we look for care? 
 Near Your Home. 
Near Your Work. 

How many children do you have: 
  

Ages of your children:
In order to complete the search, we must know each of your
children's birthdate. Thank you

Will you need full or part time care? 
 Full Time. 
Part Time. 
Before and After School Only. 

Days of the week you will need care:
Please tell us the days of the week and the hours
that you will need care. Remember to let us know
if evening or weekend care is needed. Thank you.  




Statistical Information
Which best describes you? 
 Married. 
Single. 

Person requesting a Child Care search? 
Mother. 
Father. 
Other Relative. 
Caseworker or Other. 

What is your family size? 
 

Do you receive State Subsidy to help pay for your child care?
Yes. 
No. 

What type of subsidy do you receive? 
  

Anything else we should know about your child?
ie. special needs, allergies to foods or pets, etc. 
 


Please press the "send" button only once.
Thank you!

 

Child Care Action Council is a United Way Agency Member for Thurston, Mason and Lewis Counties. CDF #176032
 

 

Equal Opportunity: The Child Care Action Council affords equal opportunity to all employees. prospective employees, and clients without regard to race, color, sex, religion, age, marital status, disability, veteran status or national origin.