Application for Supervised Home Child Care

Application for Home Child Care

Welcome to Children's Village of Ottawa-Carleton!

In order to help us find a suitable home child care provider, we ask that you share us as much information about your situation as possible (work locations, hours, mode of transport, medical conditions etc.). We will consider the location, hours, start dates, numbers and ages of children currently in care, and the overall suitability of the home when determining a match for you.

We will contact you once we can predict there is a suitable space available, and we look forward to working with you and your family.

Which Child Care Advisor are you submitting these forms to? *If you have been working with a Child Care Advisor, please select their name. Otherwise, select "No Advisor Assigned Yet"

How many of your children require childcare? *1234

Child # 1 Information

Child's Name *

Birthdate *

Do they attend school? *YesNo

Name of school: *

Child #2 Information

Child's Name *

Birthdate *

Do they attend school? *YesNo

Name of school: *

Child #3 Information

Child's Name *

Birthdate *

Do they attend school? *YesNo

Name of school: *

Child #4 Information

Child's Name *

Birthdate *

Do they attend school? *YesNo

Name of school: *

Parent/Guardian Contact Information

Name of Parent/Guardian *

Home Address *

Phone *

Email Address *

Work SituationWorkingStudentJob SearchOntario Works

Location & Accessibility

In which regions/neighbourhoods of Ottawa are you looking for care? *To help us maximize your chance of finding a great match, expand the search by listing several locations. For example, we may have providers close to your home, close to your work, or anywhere in between. You may list addresses, intersections, bus routes etc.

Other mode of transport

Days & Hours Requiring Care

When do you need childcare to start? *

Are you flexible with the start date? *YesNo

Please describe your shift work schedule

Drop off time: *

Hours

Minutes

Please enter the earliest time you need to drop off.

Pick up time: *

Hours

Minutes

Please enter the latest time you will pick up.

Do you require any Special Hours?*Early Drop Off (Before 6:30a.m.)Evening Care (After 6:00p.m.Extended Hours (Over 10 hours for Full Day, or 4 hours for School Age)Overnight Care*Additional fees apply. Subsidy approval may be required.

Fees

Do you require a subsidy from the City of Ottawa? *YesNo

What is the status of your subsidy application? *Application complete and funds approved by case worker.Application complete and waitlisted.Application complete and waiting for approval.Subsidy required but application not complete.

Are you willing to pay for childcare until your subsidy is approved? *YesNo

Child's Needs

Preferred Language *

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

Please describe your child's medical condition/special need/allergies:

Is there any other information that would help us to find the right provider for your family?

Child # 1 Information

Child #2 Information

Child #3 Information

Child #4 Information

Parent/Guardian Contact Information

Location & Accessibility

Days & Hours Requiring Care

Fees

Child's Needs

Address & Phone

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