WELL Back-up Child Care and MILDLY ILL Back-up Child Care
Pre-registration/Pre-enrollment Forms
The Family Services Office must receive the completed, required forms three (3) business days in advance of the parent requesting/reserving care.
With questions, contact Nicole Studt, Family Services Office, nicole-studt@uiowa.edu or call 319-335-1371.
Parents may pre-register/pre-enroll with both or one of the programs. Forward completed forms to:
Nicole Studt
UI Family Services Office
121-50 University Services Building
(121-50 USB)
319-353-2384 (fax)
Thank you.
Pre-registration/Pre-enrollment Forms
| Forms Required for Both Programs | Forms Required for Handicare, Inc. | Forms Required for Caring Hands & More, Inc. |
| Selection of Provider
(pdf) Must be submitted prior to requesting/reserving care. |
Health Form
(pdf) May substitute own record if existing. Must be submitted prior to requesting/reserving care. |
Description of Mild Illness (pdf) Is completed by parent when reserving care for an ill child. |
| Child’s Information Sheet
(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. |
Permission to Give Medication (pdf) Is completed by parent when reserving care for an ill child. |
| Parental Authorization
(pdf) Must be submitted prior to requesting/reserving care. |
Iowa Child and Adult
Care Food Program
(pdf) Must be submitted prior to requesting/reserving care. |