Dayhome Application Form

Name

Phone Number

Country of citizenship:

Are you over 18 years of age?

Yes

No

Address

Name of Neighbourhood

Are you a permanent resident of Canada that can legally work in Canada?

N/A - I am a Canadian citizen.

Yes

No

A permanent resident is someone who has been given permanent resident status by immigrating to Canada, but is not a Canadian citizen. Permanent residents are citizens of other countries. A person in Canada temporarily, like a student or foreign worker, is not a permanent resident.

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

Do you own your home?

Yes

No

Do you have permission from your landlord to operate a dayhome?

I own my home

Yes

No

Do you have a yard?

Yes

No

Is your yard fenced?

Yes

No

Does anyone in your household smoke?

Yes

No

​Other than yourself, how many individuals live in the home that are 18 years or older?

Do you have children of your own? (age and gender)

Are you presently caring for children other than your own?

Yes

No

What makes you interested in becoming a Dayhome Provider?

Are you committed to being a long-term quality educator?

Yes

No

When would you like to start your dayhome?

Work History

Education Level 1 or Child Development Assistant Level 2 or Child Development Worker Level 3 or Child Development Supervisor N/A Other (See Below)

Education (Other)

Have you ever been with another Dayhome Agency?

Have you been out of the child care field for 6 months or more?

Yes

No

If yes were you in the field for more than 6 months before leaving?

Not applicable

Yes

No

Languages spoken (other than English)

Do you have pets? If so, what kind and how many?

Days Available

Hours available

What play/child care equipment do you have?

Are you planning to use your vehicle to transport children?

Maybe

Yes

No

What type of activities would you provide for the children?

List 5 examples of field trips you would take with the children and how you will get there

What form of child guidance do you use?

What ages of children would you prefer to care for?

How many?

Where in your home will you be setting up your playspace?

How did you hear about us?

Comments or Questions?

Email Address