BBGH has a goal of providing high quality, play based child care to the working parents of BBGH and the community of Box Butte County. Please take a couple minutes and tell us about your current situation and your needs. We will take this information and develop a center that works for you!

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* 1. Please provide us with your contact information

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* 2. Would you be interested in joining the child care team at Box Butte General Hospital?

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* 3. Do you have an interest in bringing your child(ren) to the BBGH Child Care Center?

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* 4. How many children do you have that are between the ages of Newborn to 18 months old in child care?

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* 5. How many child(ren) do you have that are between the ages of 18 months to 3 years old in child care?

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* 6. How many child(ren) do you have between the ages of 3 years to 5 years in child care?

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* 7. How much are you currently paying for Child Care?

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* 8. Is that:

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* 9. Do you receive payment assistance with your child care arrangements?

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* 10. What are your current payment arrangements with your child care provider?

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* 11. How often would you need Child Care?

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* 12. What specific days would you need to utilize child care?

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* 13. Please add any additional comments, question or concerns.

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