Calgary Application Name: * Phone Number: * Address: Community What type of home do you live in? Select an item House Townhouse Apartment Do you have a Yard? YN Is your yard fenced? YN Days available? Hours available? Languages Spoken (other than English) Do you have pets? Non-Smoking House YN When would you like to start your dayhome? Previous Child Care Experience? What play/child care equipment do you have? Are you willing to transport children? YN What makes you interested in becoming a Dayhome Provider? What ages of children would you prefer to care for? How many? Can you give some example of activities you can do with the children? Do you have children of your own? (name, age and gender) Are you presently caring for children other than your own? YN How would you rate your home for cleanliness?(1-10) Have you ever been with another Dayhome Agency? How did you hear about us? Your e-mail address? Comments or Questions?

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