Child Care Enrollment Application For Dependents of NYC Health + Hospitals Employees

Please complete this form to apply for high-quality care for your children. Child care services include 24/7 access to a network of vetted and accredited child care centers and in-home caregivers. Click here to read frequently asked questions.

Employee Information

First Name *

Last Name *

Employee Date of Birth *

(for internal use related to FEMA reimbursement only)

Facility *

Department *

Employee ID # *

Your Employee ID is your 9-digit TKID number found on the backside of your Employee Photo-ID Card

Office Title *

Home Address *

Email *

Telephone # 1 (Mobile)*

Telephone # 2 (Home) *

Employee Work Schedule

(days/hours when you need child care services)

Zip code where you would like to access childcare: *

Dependent(s) Information

Number of Dependents:

Child # 1:

Child First Name *

Child Last Name *

Date of Birth (mm/dd/yyyy) *

Child # 2:

Child First Name *

Child Last Name *

Date of Birth (mm/dd/yyyy) *

Child # 3:

Child First Name *

Child Last Name *

Date of Birth (mm/dd/yyyy) *

Child # 4:

Child First Name *

Child Last Name *

Date of Birth (mm/dd/yyyy) *

Child # 5:

Child First Name *

Child Last Name *

Date of Birth (mm/dd/yyyy) *

I attest that:

I am an active employee of NYC Health + Hospitals.
Each of the children in this form are my dependents.

You acknowledge and understand that this website uses a service called Google reCAPTCHA to prevent abuse. Google reCAPTCHA works by collecting hardware and software information, such as device and application data, and sending these data to Google for analysis. The information collected in connection with your use of the service will be used for improving reCAPTCHA and for general security purposes. It will not be used for personalized advertising by Google. Please review the Privacy and Terms policies.

{{item}}