City View Centre for Child and Family Services 

Home Child Care Program

PARENT REGISTRATION FROM

Parent Information
Provider Information
Parent Registration & Fee

 

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City View Centre for Child & Family Services - Home Child Care will attempt to find the most suitable match of Provider and home child care environment for your child(ren). To facilitate this process, please complete the following information and submit by clicking the "submit form" button below. Your application for the child(ren) listed will then go onto our waiting list. Should a suitable space become available, a Child Care Advisor will contact you immediately. If you require assistance completing this form, do not hesitate to call us at 823-7088 between the hours of 8:30 a.m. and 4:30 p.m.

Parent/Guardian Information

 

First Name:
Last Name:
Street Address:
City
Province
Postal Code
Email Address:
Home Phone Number:
Work Phone Number:
Other Number:

 

Child Information
 
Child #1
 
First Name:
Last Name:
Birth Date (Month/Day/Year)
School Name:
Grade:

Does your child have allergies,
medical conditions or any special needs?

 YES NO
If yes, please describe:
Is there anything else we should be aware of that would affect your child(ren)'s care? YES NO
If yes, please describe:
 
Child #2
 
First Name:
Last Name:
Birth Date (Month/Day/Year)
School Name:
Grade:

Does your child have allergies,
medical conditions, or any special needs?

 YES NO
If yes, please describe:
Is there anything else we should be aware of that would affect your child(ren)'s care? YES NO
If yes, please describe:
 
Child #3
 
First Name:
Last Name:
Birth Date (Month/Day/Year)
School Name:
Grade:

Does your child have allergies,
medical conditions, or any special needs?

 YES NO
If yes, please describe:
Is there anything else we should be aware of that would affect your child(ren)'s care? YES NO
If yes, please describe:
 
Child #4
 
First Name:
Last Name:
Birth Date (Month/Day/Year)
School Name:
Grade:

Does your child have allergies,
medical conditions, or any special needs?

 YES NO
If yes, please describe:
Is there anything else we should be aware of that would affect your child(ren)'s care? YES NO
If yes, please describe:
General Information  
   
1. Do you require a subsidized space with our agency? Yes    No 
2. Is your child(ren) currently enrolled in a subsidized program now? Yes    No 
If yes, please indicate name of program:
3. Please indicate an approximate date for care to start (Month/Day/Year)
4. What hours of care do you need? From: To:

 

5. Please check the days care will be needed.

Monday        Tuesday        Wednesday        Thursday        Friday         Saturday     Sunday    


6. Do you have access to a vehicle for transporting your child to the Provider's home? 

Yes       NO   

If yes, to what areas of the city are you willing to travel for care? (Please List)

If no, how will you be bringing your child(ren) to the Provider's home?

Bus       Walking      

7. Some Providers have family pets (ex. dog or cat). Please indicate your preference.

Pets are acceptable        No Pets   

8. Please indicate any other requirements or restrictions that may assist us in securing the most suitable Provider for your child(ren).