Applying For Child Care Would you like to explore child care opportunities with TotLot Licensed Childcare? *Asterisks denote mandatory fields. *START DATE for regular care: If you would like a gradual entry into care, please indicate a transition start date: *Are you already registered on the City of Ottawa's Child Care Registry and Waitlist (CCRAW)? YESNO Do you require SUBSIDY or will you pay the fee yourself (FEE-PAYER)?Require subsidyFee-payerUnknown *Please choose locations(s) where care is required: (these are the only locations our Agency services)BarrhavenRiverside SouthManotickKanataStittsville Closest main intersection to your home: & *Transportation to day care: CARBUSWALK Language(s) preferred: Bilingual only: Would you accept care in a home where only English is spoken? YESNO *Are you comfortable with pets in the child care provider's home? (add comments, if necessary) CHILD #1 *Child's last name: *Child's first name: *Child's birthdate: Gender: *Child's home address: house number, street, city, postal code Child's school name (if applicable): *Days care is required: MONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYSATURDAYSUNDAY *Hours care is required: to Comments regarding days/hours of care: 1. Please describe special needs, allergies, special diet, etc.: 2. Please describe your child's current day care arrangement: 3. Any additional information (i.e. medical, behaviour, child's personality, etc.): CHILD #2 Child's last name: Child's first name: Child's birthdate: Gender: Child's home address: house number, street, city, postal code Child's school name (if applicable): Days care is required: MONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYSATURDAYSUNDAY Hours care is required: to Comments regarding days/hours of care: 1. Please describe special needs, allergies, special diet, etc.: 2. Please describe your child's current day care arrangement: 3. Any additional information (i.e. medical, behaviour, child's personality, etc.): PRIMARY CONTACT *Primary contact last name: *Primary contact first name: *Primary contact's relationship to child: *Best telephone number(s) to reach you at during business hours, in order to arrange interviews: *Primary contact email address: *Does primary contact have the same home address as the child? YESNO *Primary contact's work address: SECONDARY CONTACT Secondary contact last name: Secondary contact first name: Secondary contact's relationship to child: Does secondary contact have the same home address as the child? YESNO Secondary contact's work address: Information, views, or opinions regarding your child's care:i.e. nutritional preferences, electronics/television use, particulars regarding day care environment, etc. *How did you hear about TotLot Licensed Childcare? Additional comments: *Typed signature: *Date:
