Day Drop off Time spent in
school Pick up
mon tues wed thur fri
Schedule for placement in child care while custodian is working or studying
Time spent in child care = custodian's working hours and reasonable time for travel
Child´s name: Social security number
(10 digits):
Place of care:
Unit:
Placement from date:
If the schedule is the same for all weeks simply fill in the hours and time for week 1. Instructions can be found on the next page.
Day Drop off Time spent in
school Pick up
mon tues wed thur fri
Day Drop off Time spent in school Pick up
mon tues wed thur fri
Day Drop off Time spent in
school Pick up
mon tues wed thur fri
Day Drop off Time spent in
school Pick up
mon tues wed thur fri
Day Drop off Time spent in
school Pick up
mon tues wed thur fri
Date:
Parent/custodian signature:Week 1: Week 2:
Week 3: Week 4:
Week 5: Week 6:
Example
If the schedule is the same for all weeks simply fill in the hours and time for week 1.
Day Drop off Time spent in
school Pick up
mon 06:30 13:30
tues 07:00 18:30
wed 07:00 14:30
thur 08:30 17:30
fri 09:30 18:00
Day Drop off Time spent in
school Pick up
mon 07:00 08:20-13:20 15:30 tues 07:00 08:20-13:20 17:00 wed 07:00 08:20-14:40 16:30 thur
fri 07:30 08:20-13:20 14:00
Day Drop off Time spent in
school Pick up
mon 13:40 16:30
tues 13:20 18:00
wed 13:40 17:00
thur 07:00 08:20
fri 07:00 08:20
Ex 1: Ex: 2
Ex 3:
Only fill in a maximum of four different time posts per day.
Tom is in preschool. His days vary and his schedule
looks like this. Jasmin goes to school and after that to after school care. She does not go to after school care on thursdays. Her schedule looks like this.
Andreas spends some days in child care in the mornings and sometimes in the afternoon. His schedule looks like this.
Schedule for placement in child care while custodian is unemployed or on childcare leave
Child's name: Social security
number (10 digits):
Place of care:
Unit:
Placement from date:
Allowed time for child in child care when custodian is unemployed or on child care leave is 15 hours/week.
Day Drop off Pick up
mon tues wed thur fri
Parent/custodian signature:
