Get Onto Family Connections of Lane and Douglas Counties Database:
Open the format that best suits you. If you prefer to have a form mailed to you, please contact us at Family Connections of Lane and Douglas Counties (541) 463-3954 or 1-800-222-3290.
For Word format, you can use this form 3 ways.
1. Either enter your information right into the document, print, sign and date, and mail or fax to us. 2. Or print form first, then fill in the information, sign and date, and mail or fax to us.
3. OR you can EMAIL the form, just save your completed form on your own computer, then in your email, attach the completed form before sending. Click here to send your form to our provider consultant.
Provider Intake Form (.doc) (word doc 196 KB)
Provider Intake Form (.pdf) (Adobe Reader 83.3 KB)
Internet permission: We must have your signature giving us permission to put your child care information on the internet searchable database. This is another way parents can get referrals, other than directly calling our office. To view what this process entails, visit the Oregon Child Care Resource and Referral Network for details or to test it out. The selection is a random pull of 20 providers when a request is made.
UPDATE your program information.
Do you have changes you would like us to make? Please call us at 541-463-3308.
