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

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?

Date of care needed?

Who is your employer?

Who is your spouses employer?

Are you or your spouse employed by the Military?
Yes
No

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.

If near your work, what is your work address & zip?

How many children do you have:
1 Child 2 Children 3 Children 4 Children 5 Children

Ages of your children:
In order to complete the search, we must know each of your children's name and 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?
Two Three Four Five Six or More

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

What type of subsidy do you receive?
None Working Connections DSHS Subsidy CPS Scholarship Sliding Scale

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

CCAC Resource & Referral Policies
The information provided to you was self-reported by the provider. The child care referrals being provided are referrals and not recommendations. These providers are licensed through the State of Washington and have met state licensing requirements. To check for past licensing concerns of any child care referrals given, you can contact the Washington State Department of Early Learning (DEL).

All data collected in the course of providing referrals for child care is considered confidential. For Child Care Action Council's complete Confidentiality Policy, click here.

Child Care Action Council does not charge families for any resource and referral services.

I have read and agree to the above Resource & Referral Policies.