Louisiana’s 2nd Day Without Child Care Parent Sign Up Form
Parent's Name
*
First Name
Last Name
Parent's Email (for updates and event details)
*
example@example.com
Parent's Cell Phone Number (for text reminders)
*
-
Area Code
Phone Number
Home Zip Code ((To help track advocacy impact by district)
*
What is the name of the Child Care Center your child(ren) attend?
*
What Parish is the Child Care Center located in that your child attends?
*
Will you Join us at the Louisiana State Capitol on Tuesday, May 12, 2026?
*
Yes I will take off work on May 12, 2026, and join on the steps of the Louisiana State Capitol for 8:30 am with my Early Child Care Center and Community.
Yes I will take off work on May 12, 2026, ask the company I work for to support, and join on the steps of the Louisiana State Capitol for 8:30 am with my Early Child Care and Community.
Maybe, I need more information before deciding to not go to work on May 12, 2026
No, I can not take off from work on May 12, 2026
How does child care impact your daily life? (Short open-ended response, e.g., “I can go to work because I have child care.”)
*
What Company Do you work for? If you are a business owner please complete that form instead.
What Parish is the Company you work for located in?
Does your workplace support Early child care?
Yes
No
Unsure
Company Contact Person, if you think they would be interested in supporting or providing data.
Company Contact Number, if you think they would be interested in supporting or providing data.
-
Area Code
Phone Number
How else would you like to take action? (Select all that apply)
I will spread the word on social media.
I will email/call my legislators when I receive the toolkit.
I will invite other parents to sign up.
I will ask the company I work for to support (please provide support letter to me.)
I will share my family story.
I want to volunteer to help with the event.
Please list any thoughts, ideas, and concerns here for us:
Submit
Should be Empty: