Home Home Parents & Family Child Care Programs News and Events Home Useful Links Home   Child Care Request Form Parent Name* Address* City, State* , Zip* Phone* () - Fax () - Email Child #1 Name* Date Of Birth*(MM/DD/YYYY) Child #2 Name   Date Of Birth  (MM/DD/YYYY) Child #3 Name   Date Of Birth  (MM/DD/YYYY) Child #4 Name   Date Of Birth  (MM/DD/YYYY) Two Parent Single Parent Need Subsidy Family Size 2 < $35,292 Family Size 3 < $41,040 Family Size 4 < $43,548 Family Size 5 < $50,880 Family Size 6 < $58,212 Family Size 7 < $65,544 Family Size 8 < $72,876 Preferred Type of Care (select all that apply)   child care center Family child care   School Age Child Care Others   If you need further information, contact us:   (212) 941-0030 childcare@cpc-nyc.org   To find out if you are eligible for subsidized child care Contact Us : (212) 941-0030 childcare@cpc-nyc.org We Contact You : Day Time Phone:() -     Home |  Parents & Family |  Child Care Programs |  News and Events © CPC - Asian Child Care Referral Program - 2005 - All rights reserved