Calgary Application

Name

Phone Number

Address

Community

How many children would you like to care for?

What type of home do you live in? House Townhouse Apartment

Do you have a yard?

Yes

No

Is your yard fenced?

Yes

No

What ages of children would you prefer to care for? Please note that care for one year olds is highly sought after.

1-2 years

3-5 years

Grade 1 and older

All

Days Available

Hours available

Languages spoken (other than English)

Do you have pets?

Nonsmoking house?

Yes

No

When would you like to start your dayhome? Date

Previous Child Care Experience?

What play/child care equipment do you have?

Are you willing to transport children?

Yes

No

What makes you interested in becoming a Dayhome Provider?

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?

Yes

No

​How would you rate your home for cleanliness?

Have you ever been with another Dayhome Agency?

How did you hear about us?

Your e-mail address?

Comments or Questions?