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YMCA Childcare Resource Service

FAMILY NEEDS AND INTEREST

Please check any of the topics you would like additional information on. Your Family
Advocate will find resources near you for the topics selected.

________ Are you looking for a new or additional child care provider?
(Choosing Child Care, referrals, Wellness Champion Providers)

________ Do you have questions about your child’s social, emotional, or physical
development?
(Autism, Behavioral/ Developmental Resources, Diagnosis, Events/Family Engagement Activities)

________ Are you looking for a better or different job?

(Job Post, Career Centers, Resume Building, Interview skills, job fairs)

________ Do you need assistance accessing healthy food?

(WIC, Food Bank/ Pantry, Cal Fresh)

________ Are you interested in recipes and healthy eating tips for your family? (Recipes,
Fitness, Insurance, Nursing/ Pregnancy, CRS Health Educators, Wellness Champion Providers)

________ Do you want to be more active with your family, and/or get discounted
YMCA memberships? – Branch: ______________________
(YMCA discounts, Family Time activities, Parks and Rec)

________ Do you want information on the Toy Lending Library, parenting tips,
workshops, or materials?
(Classes, Tips/ Strategies, R&R Toy and Resource Libraries, Behavior/ Developmental Resources)

________ Do you need assistance paying for utilities, transportation or housing costs?
(Housing list, SDG&E programs, emergency assistance, youth housing, San Diego MTS discounts/ schedules)

________ Are you interested in family therapy or counseling services?

(Individual, children, family)

________ Would you like to speak with a professional about custody, immigration
rights, restraining orders or other legal matters?
(Volunteer Lawyers, Child Support, Family Court, Legal Aid)

________ Other: ________________________

________ I have no need for information at this time

_______________________________________ _________________________
Print Name Date
_______________________________________ _________________________
Address Telephone
_____________________________
Email

--STAFF USE--
Resources given to parent: ___________________________________________________________
Family Advocate: _________________________ Task set for follow up call on (date):