Application to Provide Supervised Home Daycare

    A. Personal Information

    Last Name:
    First Name:
    Street:
    City:
    Postal Code:
    Telephone (H):
    Telephone (C):
    Fax:
    Email Address:
    Language Spoken: EnglishFrenchOther

    B. Home environment

    Indicate children in your household:

    Age: SonDaughterProviding care for
    Age: SonDaughterProviding care for
    Age: SonDaughterProviding care for
    Age: SonDaughterProviding care for
    Age: SonDaughterProviding care for

    Please indicate if any other adults in your household are over 18 years of age:

    Spouse/parentSon/daughterRoomer/boarderRelativeOther

    C. Experience

    Address & Phone

    Children’s Village of Ottawa Carleton

    333 Churchill Ave.,
    Ottawa, ON K1Z 5B8

    Phone: (613) 725-2040
    Fax: (613) 725-9516