Home Child Care Provider Application

Provider Information

Name(Required)

First Last

Gender(Required)

Male

Female

Address(Required)

Street Address City Postal Code

Closest Main Intersections(Required)

Years at this Address(Required)

Date of Birth(Required)

Language Spoken(Required)

Email(Required)

Phone Number(Required)

Child Care Experience

Reasons for wanting to become a provider?(Required)

Previous child care experience?(Required)

Are you currently caring for children in your home? How many?(Required)

Other work experience?(Required)

Are you a Registered Early Childhood Educator (RECE)? Registration:(Required)

Do you have Standard First Aid/CPR? Expiry Date:(Required)

How did you hear about Let’s Grow?(Required)

Preferred Schedule

Which child care option are you interested in?(Required)

Option A, Full Agency: all children placed in Providers care are placed by the agency and therefore are agency clients.

Option B, Mixed: This option gives Providers the flexibility to find their own clients and receive agency clients.

Would you work full time or part time?(Required)

Full time

Part time

What hours would you work?(Required)

Are you interested in providing evening care?(Required)

What ages do you prefer to work with?(Required)

How many children are you interested in caring for?(Required)

House Information

Type of house?(Required)

Ownership?(Required)

Outdoor areas fenced?(Required)

Do you have a pool?(Required)

Is your home pet friendly?(Required)

Type of pet?(Required)

Closest schools?(Required)

Please provide Information on each member living in the home.

References

Please provide us with four references. References must not reside in the same house as provider.

References 1

Name(Required)

First Last

Phone(Required)

Email(Required)

References 2

Name(Required)

First Last

Phone(Required)

Email(Required)

References 3

Name(Required)

First Last

Phone(Required)

Email(Required)

Provider Application

Provider Information

Child Care Experience

Preferred Schedule

House Information

Please provide Information on each member living in the home.

References

References 1

References 2

References 3

Phone

How To Find Us

CONNECT WITH US