Childcare Provider Request Form

The Erie County Department of Health has developed an e-mail system to notify childcare providers of countywide health related issues (infectious diseases, lead poisoning prevention, immunizations, asthma, injury prevention, nutrition, etc.). This system will allow us to communicate with you the childcare community in a timely fashion.

Please consider participating in this important community and public health initiative at your earliest convenience. To register, simply complete the requested information below and click on the submit button. (Or, please print this form and fax to 716-961-6897.) All information provided will remain confidential.

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