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PRELIMINARY APPLICATION FORM FOR PROVIDERS

Please List Other Persons Regularly in Your Home:

Person 1

Date of Birth
Year
Month
Day

Person 2

Date of Birth
Year
Month
Day

Person 3

Date of Birth
Year
Month
Day

Person 4

Date of Birth
Year
Month
Day

Person 5

Date of Birth
Year
Month
Day
Availability to Provide Care:
Do You Smoke?
Yes
No
Does Anyone in Your Home Smoke?
Yes
No
Are Your Vaccinations Up to Date?
Yes
No
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
Are you currently working with another home child care agency?
Yes
No
Are You a Registered Early Childhood Educator (RECE)?
Yes
No
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Land Acknowledgement

Global Child Care Services is located on the traditional, unceded, unsurrendered territory of the Anishinaabe Algonquin Nation. We honour the people of the Algonquin Nation, whose presence here reaches back to time immemorial. We are grateful to have the opportunity to deliver early learning and child care services to families on this land. We acknowledge the important role of early childhood education in the pathway to Reconciliation, and we commit to this journey with intentional, inclusive and thoughtful programming for the children in our care.

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