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CHILD CARE PROVIDER
CONSENT FOR RELEASE OF CONFIDENTIAL INFORMATION

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If you are willing to accept Raising Riley scholarships currently or in the future and would like your
business advertised on our website please fill out the release below.

If you would like the Raising Riley Child Care Assistance Program to release your contact
information to parents seeking child care through:

  • Raising Riley’s website

  • Via email

  • Family Child Resource Center

  • Phone

I give consent to the Raising Riley Child Care Assistance Program to release my name, address, and telephone number as a licensed child care provider to parents seeking child care.This consent is valid from the date below until I submit a written request otherwise, or until I close my child care business.

Thanks for submitting!