Air Force Family Child Care Expanded Child Care

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Air Force Family Child Care Expanded Child Care (AF FCC ECC)
AF FCC Subsidy – complete only if applicable –
I am requesting enrollment in the AF FCC Subsidy Program. I understand I am required to be on the waiting list
for either the CDC or SA Program (if applicable). If I am offered a full-time space in the CDC or SA Program and I
decline the space and there is no active waiting list (meaning another child/youth to take the space), then AF FCC
Subsidy is discontinued.
________________________________________________________
_________________________
Parent Signature
Date
AF FCC EDC
I am required to work in support of mission requirements. There is no one else in my home available to provide
care during the hours that I am required to work. For Missile and Supplemental Care, provide a copy of your
monthly work schedule(s).
Extended Duty Care
Missile Care
Supplemental Care
I purchase regular child care from: CDC
FCC
SA Program
Other:___________________
_________________________________________________________________________________________________
I meet the requirements to use the following program:
Home Community Care – I am required to work my primary UTA weekend and there is no one else in my home
available to provide care during the hours I am required to work.
Returning Home Care - I am returning from a deployment of 30 days or more.
PLAYpass Pre-Deployment Child Care - I am scheduled to deploy within 30 days. Provide a copy of orders
with request.
PLAYpass Deployment Child Care – My spouse is deployed for 30 days or more. Provide a copy of orders
with request.
Medical Care - I am experiencing a medical emergency for a family member. Approval required by
AFPC/SVPYC.
Wounded Warrior Care - I am a Wounded Warrior and I require hourly child care to attend appointments.
Approval required by AFPC/SVPYC.
Child Care for Fallen Warriors - I have a fallen military family member and require hourly child care for
appointments. Approval required by AFPC/SVPYC.
Permanent Change of Station Child Care – I am an Army, Marine, or Navy member assigned to an active duty
AF Installation and I am requesting 20 hours of child care during my PCS move.
OCONUS Respite Care – I have an Exceptional Family Member (EFM) Child and I am requesting respite care.
Approval required by AFPC/SVPYC – available only at select OCONUS installations.
________________________________________________________
_________________________
Parent Signature
Date
________________________________________________
________________
_________________________
Parent’s e-mail address
Duty Number
Home/Phone Number
________________________________________________________
_________________________
Supervisor’s Signature/Duty Phone
Date
CHILD’S NAME: __________________________
BIRTHDATE: ______________________
Month /Day/Year
CHILD’S NAME: __________________________
BIRTHDATE: ______________________
Month/Day/Year
CHILD’S NAME: __________________________
BIRTHDATE: ______________________
Month/Day/Year
DATES AND TIMES NEEDED ________________________________________________________________________
Air Force Family Child Care Expanded Child Care (AF FCC ECC)
AF FCC Subsidy – complete only if applicable –
I am requesting enrollment in the AF FCC Subsidy Program. I understand I am required to be on the waiting list
for either the CDC or SA Program (if applicable). If I am offered a full-time space in the CDC or SA Program and I
decline the space and there is no active waiting list (meaning another child/youth to take the space), then AF FCC
Subsidy is discontinued.
________________________________________________________
_________________________
Parent Signature
Date
AF FCC EDC
I am required to work in support of mission requirements. There is no one else in my home available to provide
care during the hours that I am required to work. For Missile and Supplemental Care, provide a copy of your
monthly work schedule(s).
Extended Duty Care
Missile Care
Supplemental Care
I purchase regular child care from: CDC
FCC
SA Program
Other:___________________
_________________________________________________________________________________________________
I meet the requirements to use the following program:
Home Community Care – I am required to work my primary UTA weekend and there is no one else in my home
available to provide care during the hours I am required to work.
Returning Home Care - I am returning from a deployment of 30 days or more.
PLAYpass Pre-Deployment Child Care - I am scheduled to deploy within 30 days. Provide a copy of orders
with request.
PLAYpass Deployment Child Care – My spouse is deployed for 30 days or more. Provide a copy of orders
with request.
Medical Care - I am experiencing a medical emergency for a family member. Approval required by
AFPC/SVPYC.
Wounded Warrior Care - I am a Wounded Warrior and I require hourly child care to attend appointments.
Approval required by AFPC/SVPYC.
Child Care for Fallen Warriors - I have a fallen military family member and require hourly child care for
appointments. Approval required by AFPC/SVPYC.
Permanent Change of Station Child Care – I am an Army, Marine, or Navy member assigned to an active duty
AF Installation and I am requesting 20 hours of child care during my PCS move.
OCONUS Respite Care – I have an Exceptional Family Member (EFM) Child and I am requesting respite care.
Approval required by AFPC/SVPYC – available only at select OCONUS installations.
________________________________________________________
_________________________
Parent Signature
Date
________________________________________________
________________
_________________________
Parent’s e-mail address
Duty Number
Home/Phone Number
________________________________________________________
_________________________
Supervisor’s Signature/Duty Phone
Date
CHILD’S NAME: __________________________
BIRTHDATE: ______________________
Month /Day/Year
CHILD’S NAME: __________________________
BIRTHDATE: ______________________
Month/Day/Year
CHILD’S NAME: __________________________
BIRTHDATE: ______________________
Month/Day/Year
DATES AND TIMES NEEDED ________________________________________________________________________

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