The purpose of this LeadCare Cook County Lead Service Line Replacement Program (“Program”) Enrollment Form (“Form”) is to help you determine eligibility for the Program. To apply for the Program, complete and submit this Form. Doing so will mean you consent to Elevate Energy (“Elevate”) and contractors contracted by Elevate (hereinafter “contractors”) carrying out Program activities. Program activities may include, but are not limited to confirming your eligibility, accessing the property identified in this Form (“Property”) at an agreed-upon time to determine if the water service line is made of lead or galvanized material, performing associated activities to confirm eligibility, and replacing your service line if it is determined to contain lead or galvanized material.
Child care providers are eligible for the Program if they meet the following requirements:
- They run a child care facility (“Facility”) which must be owned or rented by the person applying. If the child care provider rents the Facility, the Owner of the Property out of which the Facility is operated must also agree to and complete a separate application and consent form.
- The Facility is based in suburban Cook County.
- The Facility is licensed with the State of Illinois Department of Children and Family Services.
- The Program determines that the service line connecting the Property to the water main is made from lead or galvanized material.
Eligible child care providers can apply online by filling out and submitting this Form. If you don’t own the Property where your Facility operates, you still need to complete this Form and provide the name of the Property Owner. We will also have the Property Owner complete an application and consent form.
LeadCare Cook County Lead Service Line Replacement Program Application and Consent Form