After School Day Care
Family Service Association
Building Family Strengths
School-Age Child Care Screening Application
Today's date:
Parent(s) Name(s):
Address:
Telephone:
Child(ren) Name(s)
Child(ren) School(s):
Gross Monthly Income:
Family Size:
Parent(s) work (or school) schedule -- must be provided for both parents, if applicable:
This is only a screening application.  Parent(s) must complete a formal intake process that includes verification of gross monthly income (e.g. pay stubs from four of most recent six weeks), verification of all members in household (e.g. provision of birth certificates for children), verification of address (most current utility bill), and verification of service need if receiving subsidized rate by the Fall River School Department of the Commonwealth of Massachusetts.
Family Service Association
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