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CHCF Visitors Must Complete this form
If you are planing on visitng our office you must complete this form. This is out of abundance of safety for you and our staff and is also a New York State mandate from the Governor of NY.
Vistor Name
*
First
Last
Company
*
Phone
*
Email
*
Staff Visiting Name
*
Select staff member
Aida Marte
Charisse Moye
Marco Lombardini
Ramon Peguero
Andres Deschamps
Iris Cabrera
Rebekkah Boxt
Emily Murphy
Wilmaris De La Cruz
Alan Yu
Franshel Rodriguez
Michael Rodriguez
Angelica Carias
Jose Ortiz
Jazmin Lopez
Leah Van Halsema
Diana Diaz
Jennifer Mora
Christy Griffith
Danielle Demeuse
Helena Yordan
Laura Ubiera
Keila Jimenez
Mauro Satalino
Onyx Ramirez
Monique Mighty
Rosmery Marte
Nidia Carreno
Cheidy Perez
Magnolia Almanzar
Date of visit
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Time of visit
*
:
HH
MM
AM
PM
Purpose of visit
*
Please complete the following Covid-19 Survey
Have you knowingly been in close or proximate contact in the past 14 days with anyone who has tested positive for COVID-19 or who has or had symptoms of COVID-19?
*
Yes
No
Have you tested positive for COVID-19 in the past 14 days?
*
Yes
No
Have you experienced any symptoms of COVID-19 in the past 14 days
*
Yes
No
About Us
Board of Directors
Advisory Board
Executive Staff
Our Supporters
Financials
Careers & Internships
Programs & Services
Early Care and Education
For Families
Child Care Services
Child Care Resources
Child Care Information Request
For Providers
Become a Provider
Courses and Workshops
Training Calendar
Child Care Provider Regulations
CHCF Grants
ECEI Training Fee
Youth Development
After School
Community Schools Initiative
Career and College Exposure
Policy and Advocacy
Find My Polling Place
Community Engagement
News & Blog
Press Releases
Publications
Media Coverage
Contact Us
Donate
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