Child's InformationChild's Name* First Last Birth Date* MM slash DD slash YYYY Sex* Male Female The date day care is required by* MM slash DD slash YYYY Please enter the date you will need the care to begin for your childHome Address* Street Address City Postal Code Main home intersection*Parent Contact Information: Primary ContactName* First Last Cell Phone*Home PhoneEmail Address* Parent Contact Information: SecondaryName First Last Cell PhoneHome PhoneEmail Address Can we send you emails?*YesNoDCS sends periodic emails to notify parents about upcoming spaces, new provider profiles and other related newsType of Care RequiredHas your child been in daycare?* YES NO Are you interested in a childcare centre?* YES NO Are you interested in home daycare?* YES NO Required Care Start Date* MM slash DD slash YYYY Required Care End Date* MM slash DD slash YYYY Please tell us which days and hours you require care for your child*Additional InformationHave you applied for Fee Assistance with the Municipality? NOT CWELCC* Yes No If you answered yes - Have you been approved? Yes No Are pets ok?* Yes No N/A Allergies, medical and/or behavioral needs?*Please list Do you have any other children that require care?* YES NO Please list other children's names*Birth Date of Other Child* MM slash DD slash YYYY Sex of Other Child* Male Female How far north, south, east, west should we search?*Please list the boundaries that the provider should be located. Daycare location Preference*Please list things you want in home care and things you do not want. This helps us with your search.CommentsPlease Enter Any Further CommentsHow Did You Find Us?*IMPORTANT: On successful completion of this form you will see a thank you message and you will receive an email confirmation that your application has been received. If you do not see this message then you must correct the form's submission.CAPTCHA