U.S. Army Family Enrollment Falls Church 2242 City: State: VA Zip Code: Remit to Address: City: State: Zip Code: Printed Name of Qualifying Sponsor: Last First MI Child's Enrollment (start date of care): of Birth (DOB) Type of Care (check all that apply): FT PT Before School Only After School Only Before and After School Summer/Holiday Full Rate (school aged): Daily Rate = Respite Care $ _ (note: $15 maximum may be paid on behalf of each child per provider, per year) Are there any future rate or attendance changes expected within next six (6) months? GSA Subsidy Administration Program as a qualifying child care provider. *Child care rates & fees must be submitted to the annually. Only one rate Tel: (866) 58-371 Fax: (816) 926-3642 army.childcare@gsa.gov ARMY 215-1
U.S. Coast Guard Family Enrollment City: Falls Church State: VA Zip Code: 2242 Remit to Address: City: State: Zip Code: Printed Name of Qualifying Member: Last First MI Child's Enrollment (start date of care): of Birth (DOB) Summer/Holiday Full Rate (school aged): Daily Rate = (note: $2 maximum may be paid on behalf of each child per provider, per year) Are there any future rate or attendance changes expected within next six (6) months? *Child care rates & fees must be submitted to the annually. Only one rate Tel: (866) 58-371 Fax: (816) 823-5445 uscgchildcare@gsa.gov USCG 215-1
General Services Administration (GSA) Family Enrollment City: Falls Church State: VA Zip Code: 2242 Remit to Address: City: State: Zip Code: Child's Enrollment (start date of care): of Birth (DOB) Summer/Holiday Full Rate (school aged): Daily Rate = Are there any future rate or attendance changes expected within next six (6) months? *Child care rates & fees must be submitted to the annually. Only one rate Tel: (866) 58-371 Fax: (816) 823-5445 childcare@gsa.gov GSA 215-1
U.S. Customs and Border Protection (CBP) Family Enrollment City: Falls Church State: VA Zip Code: 2242 Remit to Address: City: State: Zip Code: Child's Enrollment (start date of care): of Birth (DOB) Summer/Holiday Full Rate (school aged): Daily Rate = Are there any future rate or attendance changes expected within next six (6) months? *Child care rates & fees must be submitted to the annually. Only one rate Tel: (866) 58-371 Fax: (816) 823-4582 cbp.childcare@gsa.gov CBP 215-1
National Park Service (NPS) Family Enrollment City: Falls Church State: VA Zip Code: 2242 Remit to Address: City: State: Zip Code: Child's Enrollment (start date of care): of Birth (DOB) Summer/Holiday Full Rate (school aged): Daily Rate = Are there any future rate or attendance changes expected within next six (6) months? *Child care rates & fees must be submitted to the annually. Only one rate 23 Main Stret - 2SE, Kansas City, MO 6418 Tel: (866) 58-371 Fax: (816) 823-5432 npschildcare@gsa.gov NPS 215-1