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  • DEPARTMENT OF CHILDREN AND FAMILIES
    Division of Early Care and Education

  • INTAKE FOR CHILD UNDER 2 YEARS – CHILD CARE CENTERS

  • Use of form: This form is mandatory for family child care centers to comply with DCF 250.09(1)(c)1. and for certified providers to comply with 202.08(12)(g). Failure to comply may result in issuance of a noncompliance statement. This form is voluntary for group child care centers; however, it meets the requirements of DCF 251.09(1)(am). This form collects information about children under age 2 in order to aid child care workers in individualizing the program of care for the child in a family or group child care center. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04(1)(m), Wisconsin Statutes].

    Instructions: This form is to be completed by a parent and must be on file at the center prior to a child's first day of attendance. Regular updates can be noted. This form should be kept in the room where care is provided. If additional space is needed, attach a separate sheet

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  • HEALTH

    Note: Health conditions that may affect the care of the child must be recorded on the department’s form, Health History and Emergency Care Plan. The form should be shared with any person who provides care for the child.


     

  • Meals


     

  • SLEEP


     

  • Note: Children under age 1 year must be placed to sleep on their back unless a written statement from the child's physician is attached.

  • DIAPERING / TOILETING


  • VERBAL COMMUNICATION


     

  • COMFORTING


     

  • SELF-EXPRESSION


     

  • PHYSICAL AND SOCIAL DEVELOPMENT


     



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Links

Hours of Operation

Mon - Fri:
6:30 am - 5:30 pm

Half Day Program:
8:00 am - 11:30 am

Saturday - Sunday:
Closed

About
Holy Family Childcare

The Holy Family Childcare Center is an independent, non-profit, full time child-care and preschool facility. It provides quality care and age appropriate education in a loving, stimulating, and secure environment. The Center is part of the outreach ministry of the Missionary Sisters of the Holy Family and operates on the Congregation’s property.The Center serves up to 40 children at a time, ranging in age from 6 weeks to 5 years.

Contact
Holy Family Childcare

  • 31144 Hunters Trail
    Burlington, WI 53105

Holy Family Childcare
Map and Directions

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