In this form, employees/family members provide information to enroll their child(ren) in child care slots through the Partner Up! program.
Information must be filled out completely, as it will be used to determine eligibility. Information will only be accessible to BCCAs and DCF for the purposes of verification under Partner Up! Personal information will not be shared with any other parties.
Please enter information about the employee of the Partner Up! awarded business in the following fields.