Dd Form 2606 - Department Of Defense Child Development Program Request For Care Record
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1DEPARTMENT OF DEFENSE CHILD DEVELOPMENT PROGRAM
REQUEST FOR CARE RECORD
PRIVACY ACT STATEMENT
AUTHORITY: PL 101-89 Sec. 1507; EO 9397.
ROUTINE USE(S): None.
PRINCIPAL PURPOSE(S): To collect applicant information for Child
DISCLOSURE: Voluntary; however, failure to furnish requested
Development Programs and place applicants on waiting lists for
information will result in an incomplete request for care record and
program services. Information compiled from applications is also used
possible loss of placement on Child Development Program waiting
to assist management determination of effectiveness of present and
lists.
projection of future program requirements.
1. DATE OF REQUEST (YYYYMMDD)
2. EXPIRATION DATE (YYYYMMDD)
3. FAMILY INFORMATION
a. SPONSOR'S NAME (Last, First, Middle Initial)
b. SPOUSE'S NAME (Last, First, Middle Initial)
c. CHILD'S NAME (Last, First, Middle Initial)
d. CHILD'S DATE OF BIRTH (YYYYMMDD)
e. CHILD'S AGE
f. HOME ADDRESS (Street, City, State, Zip Code)
g. SPONSOR'S BRANCH OF SERVICE
h. DUTY ORGANIZATION
i. HOME TELEPHONE NUMBER (Include Area Code)
j. DUTY TELEPHONE NUMBER (Include Area Code)
k. SIBLING CARE (Complete a separate form and list name and date of birth for each child requiring care)
(2) DATE OF BIRTH
(2) DATE OF BIRTH
(1) NAME (Last, First, Middle Initial)
(1) NAME (Last, First, Middle Initial)
(YYYYMMDD)
(YYYYMMDD)
5. AGE GROUP (X one)
4. PROGRAM(S) DESIRED (X as applicable)
a. FULL-DAY CARE
e. FAMILY DAY CARE (FDC)
a. INFANTS (0 - 12 months)
b. PART-DAY CARE
f. PART-DAY ENRICHMENT
b. TODDLERS (13 - 35 months)
c. SCHOOL-AGE
g. DAY CAMP
c. PRESCHOOL (3 - 5 years)
d. SPECIAL NEEDS
d. SCHOOL AGE (5+ years)
6. SPONSOR STATUS (X one)
a. SINGLE MILITARY
e. SINGLE DOD CIVILIAN
i. MILITARY/UNEMPLOYED SPOUSE
b. DUAL MILITARY
f. RETIRED MILITARY
j. MILITARY/OTHER THAN DOD SPOUSE
c. MILITARY/DOD SPOUSE
g. MILITARY RESERVE
k. OTHER (Specify)
d. DUAL DOD CIVILIANS
h. NATIONAL GUARD
7. PRESENT CHILD CARE ARRANGEMENTS (X as applicable)
a. FDC ON-INSTALLATION
d. CIVILIAN CDC
g. IN-HOME CARE
b. FDC OFF-INSTALLATION
e. MILITARY ALTERNATE CARE
h. NO PRESENT CARE
i. OTHER (Specify)
c. OTHER MILITARY CHILD
f. NON-MILITARY ALTERNATE
DEVELOPMENT CENTER (CDC)
CARE
8. GENERAL INFORMATION (X and complete as applicable)
YES
NO
YES
NO
a. IF CHILD IS NOT PRESENTLY IN CARE, IS EMPLOYMENT
c. IS CHILD ON OTHER MILITARY WAITING LIST?
OF SPOUSE AWAITED? (If Yes, estimate average annual
(If Yes, name installation)
income lost)
d. CURRENT COST OF CARE PER WEEK (If child is currently in care)
b. HAS CHILD BEEN IDENTIFIED FOR SPECIAL NEEDS
CARE?
9. UPDATE REQUIRED PER INSTRUCTIONS (For Office Use Only)
(1)
(2)
(3)
(4)
(5)
a. DATE CALLED
(YYYYMMDD)
b. DECLINED/
PLACED
c. COMMENTS/
INITIALS
d. PLACEMENT TIME
(In months)
DD FORM 2606, JUL 1998
PREVIOUS EDITION MAY BE USED.
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