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info@gccs.ca
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Garderie Héritage Child Care Centre
Service de Garde à Domicile
Info pour parents
Frais pour services de garde d’enfants
Application pour services de garde
Info pour responsables de garde
Formulaire d’application préliminaire
Politique de confidentialité
Politique d’accessibilité
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PRELIMINARY APPLICATION FORM
FOR PROVIDERS
Name (First & Last)
*
Address
*
Postal Code
*
Phone Number
*
Email
*
Language(s) Spoken:
*
Schools in Your Area
*
Please List Other Persons Regularly in Your Home:
Person 1
Name
*
Date of Birth
*
Month
Day
Year
Relationship to You
*
Hours Normally in Home
*
Person 2
Name
Date of Birth
Month
Day
Year
Relationship to You
Hours Normally in Home
Person 3
Name
Date of Birth
Month
Day
Year
Relationship to You
Hours Normally in Home
Person 4
Name
Date of Birth
Month
Day
Year
Relationship to You
Hours Normally in Home
Person 5
Name
Date of Birth
Month
Day
Year
Relationship to You
Hours Normally in Home
Ages of Children You Would Like to Care For:
Availability to Provide Care:
*
Daytime
Evenings
Weekend
Preferred Hours of Care:
Do You Smoke?
*
Yes
No
Does Anyone in Your Home Smoke?
*
Yes
No
Are Your Vaccinations Up to Date?
*
Yes
No
Comment
Do You Have a Swimming Pool, Pond Or Hot Tub?
*
Yes
No
Do You Have Pets?
*
Yes
No
Are You Currently Caring for Children in Your Home?
*
Yes
No
If Yes, How Many Children and What Are Their Ages?
Are you currently working with another home child care agency?
*
Yes
No
Has Anyone Referred You to Our Service?
Are You a Registered Early Childhood Educator (RECE)?
*
Yes
No
Other Training, Education and/or Experience Related to Child Care:
Submit
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