Join the WECA Food Program

Do you currently have children in care? (at least one child that is not your own nor related to you) Do you currently have children in care? (at least one child that is not your own nor related to you) Yes No - please fill out this form when you do.

I am a family child care provider. Please contact me. I am a family child care provider. Please contact me. I am a family child care provider. Please contact me.

Are you currently a certified or licensed child care provider? Are you currently a certified or licensed child care provider? Yes No

First Name

Last Name

Phone

Email Address

Child Care Program Address

City

County

Zip

In what language do you prefer to receive information? In what language do you prefer to receive information? English Spanish

Have you participated in the Child and Adult Food Program before? Have you participated in the Child and Adult Food Program before? Yes No Not sure

How did you hear about us? How did you hear about us? WECA Website WECA Email WECA Food Program Postcard WECA Staff Member Referred by another child care provider Social Media Other