Child Care Provider List Request | Early Learning Coalition of the Emerald Coast

Child Care Resource & Referral will provide you with a list of child care providers to call and visit. The list does not rate or recommend providers. We encourage all parents to check the files for all licensed and registered providers at the Department of Children and Families. All provider listings will be sent to you, either by mail or email within 2 business days of receiving the online request.

Should you have any questions for a Family Services Specialist, please call (850) 833-3627.

All information received is confidential and will not be sold or given to any third party.

Parent Name(Required)

First Last

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

County

Contact Phone Number(Required)

Email Address(Required)

Type of care desired(Required)

Before and After school

Child Care Center

Family Child Care Home

Nanny

Play Group

Summer Camp

Are you looking for care near(Required)

Home

School

Work

Please provide address if previous selection was Work or School

Days of care per week

Hours of care per day

Reason for change in care

Problem finding care

Number of adults in household

Please list the children in need of care below.

If you are pregnant and are searching for child care, please enter the child's expected date of birth.

Child 1 Name

First Last

Child 1 Date of Birth Month

Child 1 Date of Birth Day

Child 1 Date of Birth Year

Child 2 Name

First Last

Child 2 Date of Birth Month

Child 2 Date of Birth Day

Child 2 Date of Birth Year

Language Preference

Relationship to child

Does your child have any special need?

Do you have any concerns about your child's development?

Preferred method of response

U.S. Mail

Fax

Fax number (optional)

Show us you're human to see the submit button – which letter is missing in A B C D __ F G?(Required)