Registration Forms for Back-up Child Care

Mother with ill child
Mother with ill child

The Family Services Office must receive the completed, required forms two (2) business days in advance of the parent requesting/reserving care. Contact Family Services or call 319-335-1371.

Parents may pre-register/pre-enroll with both or one of the programs. Forward completed forms to:

Diana Kremzar
UI Family Services Office
121-50 University Services Building
319-353-2384 (fax)

List of Forms for Back-Up Child Care
Forms Required for
Both Programs
Forms Required for
Handicare, Inc.
Forms Required for
Caring Hands & More, Inc.
PDF iconSelection of Provider (pdf)
Must be submitted prior to requesting/reserving care.
PDF iconHealth Form (pdf)
May substitute own record if existing. Must be submitted prior to requesting/reserving care.
PDF iconDescription of Mild Illness (pdf)
Is completed by parent when reserving care for an ill child.
PDF iconChild Information Form (pdf)
Must be submitted prior to requesting/reserving care.
Immunization Record (pdf)
May substitute own record if existing. Must be submitted prior to requesting/reserving care.
PDF iconPermission to Give Medication (pdf)
Is completed by parent when reserving care for an ill child.
PDF iconParental Authorization for Pick Up (pdf)
Must be submitted prior to requesting/reserving care.
PDF iconIowa Child and Adult Care Food Program (pdf)
Must be submitted prior to requesting/reserving care.