Holding Hands registration form

Parent Form

There are times when something comes up, such as a family event, PTA, important meetings, or appointments, and you need temporary childcare for your child with developmental delays.

Our Holding Hands group is here to meet that need. Whether for private pay, respite hours, or even volunteer work, our team is here to care for your child

Registered families can call in at any time, and we’ll b’ezras Hashem get your request covered.

Step 1 of 19

What’s your child first name?*
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What’s your child last name?*
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What’s your child Date Of Birth?*
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Date Format: MM slash DD slash YYYY

Where do you currently live?
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What’s your child father’s name?
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What’s your child father’s cell number?
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What’s your child father’s shul affiliation?
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What’s your child mother’s name?
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What’s your child mother’s cell number?
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What’s your home phone number?
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What’s your Email Address?
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What’s your family references/contact number?
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School
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School reference name
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School reference contact number
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Please provide a brief description of your child
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What are your child’s likes and dislikes? Hobbies?
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Emergency contact name
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Emergency contact number
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Email
This field is for validation purposes and should be left unchanged.

Holding Hands registration form

Parent Form

Step 1 of 19

About Us

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718-750-1010