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Home Child Care
Overview
Info for Parents
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Info for Providers
Already a Provider?
EarlyON Drop-ins
Careers
News & Events
About Global
Overview
Our Board of Directors
Our History
Our Staff
Our Community Involvement
Donations
Contact Global
Child Care Centres
Overview
Canyon Walk Child Care Centre
Fallingbrook School Age Program
Forest Valley School Age Program
Garderie Héritage Child Care Centre
Rideau Valley Child Care Centre
Trillium School Age Program
Winterwood Child Care Centre
Home Child Care
Overview
Info for Parents
Home Child Care Fees
Info for Providers
Already a Provider?
EarlyON Drop-ins
Careers
News & Events
Français
Privacy Policy
Accessibility Policy
Français
About Global
Overview
Our Board of Directors
Our History
Our Staff
Our Community Involvement
Donations
Contact Global
Child Care Centres
Overview
Canyon Walk Child Care Centre
Fallingbrook School Age Program
Forest Valley School Age Program
Garderie Héritage Child Care Centre
Rideau Valley Child Care Centre
Trillium School Age Program
Winterwood Child Care Centre
Home Child Care
Overview
Info for Parents
Home Child Care Fees
Info for Providers
Already a Provider?
EarlyON Drop-ins
Careers
News & Events
Home
>
Application for Home Child Care
Application for Home Child Care
Step
1
of
2
50%
Full Fee
*
Yes
No
Fee Subsidy Required
*
Yes
No
If a fee subsidy is required, you will be contacted by our agency for more information.
Parent 1
Parent / Guardian
*
Address
*
Contact Information
Phone #1
*
Phone #2
Email
*
(Your email is required to receive a copy of your application)
Parent 2
Parent / Guardian
Address
Contact Information
Phone #1
Phone #2
Email
(Your email is required to receive a copy of your application)
Children's Names
Child 1
First + Last Name
*
Gender
*
- Select -
Male
Female
Birthdate
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
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2024
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1991
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1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
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1965
1964
1963
1962
1961
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1959
1958
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1956
1955
1954
1953
1952
1951
1950
1949
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1946
1945
1944
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1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Name of School
Grade
Child 2
First + Last Name
Gender
- Select -
Male
Female
Birthdate
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
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11
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29
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31
Year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
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2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Name of School
Grade
Child 3
First + Last Name
Gender
- Select -
Male
Female
Birthdate
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
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26
27
28
29
30
31
Year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Name of School
Grade
Child 4
First + Last Name
Gender
- Select -
Male
Female
Birthdate
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Name of School
Grade
In which language do you wish to receive correspondence?
English
French
How did you hear about our services?
In what geographic areas would you consider care?
Do you have a vehicle to travel to the provider’s home?
*
By what date do you require care?
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Pre-start date (if required)?
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
List the days of the week you need care:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
What time would the child(ren) arrive in care?
:
HH
MM
AM
PM
AM/PM
What time would the child(ren) leave care?
:
HH
MM
AM
PM
AM/PM
What are the most important qualities you are seeking in a child care provider?
Language(s) spoken in your home:
Does your child have:
Allergies
*
Yes
No
Please specify:
Health Concerns
*
Yes
No
Please specify:
Special Needs
*
Yes
No
Please specify:
Would you consider a home with pets?
Yes
No
Comments
Please specify any other restrictions or preferences we should consider:
Name of Person Completing this Form:
Name
This field is for validation purposes and should be left unchanged.