Childcare Provider Reference Check Form
Please complete this form to provide a reference check for a childcare provider. Your honest feedback will help ensure the highest quality of care.
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Your Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Your Relationship to the Childcare Provider
*
Please Select
Employer/Parent
Colleague
Supervisor
Friend
Neighbor
Other
Childcare Provider's Full Name
*
First Name
Last Name
How long have you known the childcare provider?
*
Please Select
Less than 6 months
6 months to 1 year
1-2 years
More than 2 years
Please describe the provider's reliability and punctuality.
*
How would you rate the provider's communication skills?
*
1
2
3
4
5
What are the provider's greatest strengths?
Do you recommend this childcare provider?
*
Yes, highly recommend
Yes, with some reservations
No
Submit Reference
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