E-Child Care Card Replacement Request

Add a Designee
Fill out the form below to request an E-Child Care Card for a designee. A designee is someone you authorize to drop off/pick up your child from the provider. A designee cannot be the child care provider or anyone who is employed by the child care provider. The designee's card will be mailed to you.

* Indicates required field

Your Name *

First

Last

Your Family ID/Case # *

Last 4 digits of your SS# *

Your Address *

Your Zip Code *

Your Email *

Designee's Name *

Designee's Date of Birth *

Submit