Parents and carers section

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Information about childcare.
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Find out how to become a registered childminder
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Information and advice on choosing childcare
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Home: Children and families: Parents and carers: Childcare: Information for parents and carers

Request for childcare form

Family Information Service - September 2010
fis@kirklees.gov.uk

Use this form to make a request for childcare services. * indicates that a field must be filled in for you to send the form.

Your details

Name and email address

First name*:
Last name*:
Your email address*:

Are you male or female?

Male
Female

Your address

Number and street / name
Area
Town
Postcode (e.g. HD1 2AD)
Telephone number (e.g. 01484 123123)

Care requirement details

What type of care is required?

Childminder
Créche
Out of school club
Private nursery
Playgroup
Playscheme

Where is the care required?

Area of Kirklees that care is required in

How many children of the age groups below is the care required for?

Under 5
5 to 8
9 to 14

Why is care required?

Starting training or education
Starting work
Child requires early education
Previous childcare arrangements broken down/no longer appropriate/available

Other details

Where did you hear about the childcare service?

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