Test Kit Registration

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Contact Person

For the child care facility

First Name

Last Name

Phone Number

Email Address

Confirm Email Address

LeadCare Illinois offers all licensed day care homes, group day care homes, and day care centers free lead in drinking water testing. Lead in water testing is mandatory for facilities serving children ages birth to six years and located in a home or building constructed on or before January 1, 2000.

Complete this form to request a testing kit from LeadCare Illinois. If you have any questions, please call us at 312-300-7074.

Child Care Facility Name

Are you a DCFS-licensed child care facility?

YesNoNo, but I’m in the process of becoming one

The LeadCare Illinois program is available to all DCFS-licensed child care providers. If you have any questions, please call us at 312-300-7074.

DCFS License Number

Child Care Facility Address

List the address where the water samples will be collected

Street

City

State

Zip Code

My mailing address is different than the child care facility's address listed above

YesNo

Contact Mailing Address

Street

City

State

Zip Code

Total Number of Children Your Facility Serves

Total Number of Children Under the Age of 6

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Does your child care facility operate out of multiple buildings?
Only select "yes" if you operate out of multiple buildings that are associated with the same DCFS license number.

YesNo

How many buildings does your child care facility operate out of?

What year was your child care home or facility built?
If your facility operates out of multiple buildings, please list the earliest year of construction.

Have you previously conducted lead in water testing at your child care facility?

YesNo

Please upload a copy of your test results. If you don’t have them on hand right now, email them to us at info@leadcareillinois.org.

Have you already developed and implemented a mitigation plan?

YesNoI’m not sure

Please upload a copy of your mitigation plan. If you don't have it on hand right now, email it to us at info@leadcareillinois.org.

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Drinking and Cooking Water Sources

The State of Illinois requires licensed child care providers to test all cooking and drinking water faucets and fixtures that are used for child care operations in the home or facility.

This includes kitchen and bathroom faucets, drinking fountains, classroom sinks, refrigerator water dispensers, and ice from automatic ice makers.

Please indicate the number of cooking and drinking water sources your home or facility will need to test.

Kitchen Sinks:

Classroom Sinks:

Restroom Sinks:

Drinking Fountains:

Water Dispensers:

Automatic Ice Makers:

Water Bottle Filling Stations:

Combo Sink and Drinking Fountains:

Combo Drinking Fountain and Water Bottle Filling Stations:

Other Drinking and Cooking Water Sources:

Please describe each “Other drinking water source”:

Please describe each of the 2 “Other drinking water source”

Please describe each of the 3 “Other drinking water source”

Please describe each of the 4 “Other drinking water source”

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Other. Please let us know.

Terms and Conditions

I have read, understand and agree to the Terms and Conditions. I acknowledge that I have completed this registration form to the best of my ability, followed the instructions provided and noted every drinking or cooking water source in my child care facility.

Lead in Drinking Water

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