Referral Statement Form | Children's Center

I understand that Family Resources does not make any representations about the fitness or quality of any program nor does it recommend any particular child care provider in its database. I further understand that it is my responsibility to determine which child care arrangement best meets my needs. I hereby release Boston University and its trustees, officers, employees, and agents from any loss, damage, liability, or expense incurred by me or any member of my family arising out of the provision of child or family care services by any third party.*

By checking this box and entering your name and BU ID number below, I agree to the above statement.

Name*

Date*

BU Affiliation*

BU ID Number*

Work Phone Number

Cell Phone Number*

Home Phone Number

Email*

Mailing Address*

Street Address Address Line 2 City State ZIP

Please check the services and/or information you are interested in:

Family Day Care
Center Day Care
In-Home Child Care
Babysitting Information
Summer Camp Information
Elementary School/Schoo-Age Information