Child Care Facility Application

Child Care Application Form

Lead Testing in Schools and Child Care Facilities Drinking Water (LWSC) Program Child Care Application Form.

Choose a county and city to select a licensed child care facility. To nominate a private, in-home, licensed childcare facility, use the “nominate a facility” form.
Physical Street Address
Mailing Address
Superintendent Name
Principal Name
Maintenance / Sampling Coordinator Name
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