Extended Hours Childcare Survey Weekdays/Saturday
Current hours of operation 6:00am to 6:00pm
Name (parent /guardian)
Email
example@example.com
Phone Number
Please enter a valid phone number.
Names of Child(ren)
Child(ren) D.O.B.
Are you currently using extended hours /weekend care with another licensed childcare centre?
Yes
No, my family assists with my child care
No, a babysitter assists with my child care
No, friends assist with my child care
Other
If answered yes above, are you using subsidized childcare?
Yes
No
Which days do you require care? (check all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Check approx hours of care you will require on WEEKDAYS (check all that apply | Current hours of operation 6:00am to 6:00pm)
6pm - 7pm
7pm - 8pm
8pm - 9pm
9pm - 10pm
Other
Monday
Tuesday
Wednesday
Thursday
Friday
If you chose "other" for above, please specify times needed here.
Check approx hours of care you will require on SATURDAYS.
7am - 8am
8am - 9am
9am -10am
10am -11am
11am - 12pm
12pm - 1pm
1pm - 2pm
2pm - 3pm
Other
If you chose "other" for above, please specify times needed here.
If we decide to offer this service in the near future, what starting date best suits your family?
-
Month
-
Day
Year
Date
Submit
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