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Early Learning Coalition of the Emerald Coast
Child Care Provider List Request
Child Care Provider List Request
Step
1
of
2
50%
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
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
County
Okaloosa
Walton
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
Caregiver no longer available
Client asked to leave
Cost too high
Employment/working
End leave of absence
Parent/child needs
Relocation
Training/education
Unhappy with quality
Other
Problem finding care
Affordability/cost
Care ending
Location
No openings
Program curriculum
Quality
Schedule
Special Needs
Type of care
None
Number of adults in household
1
2
More than 2
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
January
February
March
April
May
June
July
August
September
October
November
December
Child 1 Date of Birth Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Child 1 Date of Birth Year
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
Child 2 Name
First
Last
Child 2 Date of Birth Month
January
February
March
April
May
June
July
August
September
October
November
December
Child 2 Date of Birth Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Child 2 Date of Birth Year
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
Language Preference
English
Haitian
Korean
Russian
Spanish
Relationship to child
Parent/Step Parent
Guardian
Legal Custodian
Foster Parent
Relative
Does your child have any special need?
Do you have any concerns about your child's development?
Preferred method of response
Email
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)
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