Intake Form

Customer Intake Form

Welcome to LOCATE: Child Care's customer intake form. Please complete the form to let us know your child care needs. We will search for providers who meet your needs and send you a list of up to six providers. If at anytime you would like another list, please call us at 877.261.0060 and we can send you one quickly. If you are a full-time employee or student of Johns Hopkins University or Health System, please go to the following link: https://www.surveymonkey.com/r/T52GK6M LOCATE has an enhanced service for children who have Special Needs and an Individualized Educational Plan (IEP) or an Individualized Family Service Plan (IFSP ) If you would like to use this service, please go to https://www.surveymonkey.com/r/GD2C6T2
    DISCLAIMER: All providers listed in LOCATE: Child Care are regulated or approved by the Maryland State Department of Education or certified by the Maryland Department of Health and Mental Hygiene. When LOCATE identifies child care program options for parents, it means only that the programs identified are regulated by the appropriate agency and have met the criteria that agency sets forth. The responsibility for providing LOCATE with accurate listings of regulated providers/programs rests with the appropriate agencies. Responsibility for selecting and employing a child care provider rests with each parent. LOCATE: Child Care cannot guarantee the quality of providers in its files and urges parents to carefully interview and check references before leaving a child in care. A referral from LOCATE does not constitute a recommendation as to the quality of care.
  • MM slash DD slash YYYY
  • Best way to reach you during the day:
    If your county is not listed please visit https://www.marylandfamilynetwork.org/for-parents/locate-child-care
  • Where would you like child care?
  • Should we contact you in your native language?
  • To evaluate our service, we do follow up calls to our clients. May we call you?
  • What is your relationship to the child?
  • Household Structure?
  • Family Size of 2 the Income Limit is $61,222; Family Size of 3 the Income Limit is $75,627; Family Size of 4 the Income Limit is $90,033; Family Size of 5 the Income Limit is $104,438; Family Size of 6 the Income Limit is $118,843; Family Size of 7 the Income Limit is $121,544; Family Size of 8 the Income Limit is $124,245; Family Size of 9 the Income Limit is $126,946 Family Size of 10 the Income Limit is $1129,647;
  • Do you think you may be eligible?
  • 48. What type of Transportation will you be using?
  • First Name of Child
  • 57. Escort? Child #1:
  • :
  • :
  • 60. Are you looking for care for more than one child without an IEP or IFSP?
  • First Name of Child
  • 62. Length of Care Needed, Child #2
  • 63. Days of the week Child #2
  • 64. Hours Child #2
  • 67. Escort? Child #2:
  • :
  • :
  • First Name of Child
  • 71. Length of Care Needed, Child #3
  • 72. Days of the week Child #3
  • 73. Hours Child #3
  • 76. Escort? Child #3:
  • :
  • :

Project ACT’s Funders Include