Educator's Profile Form
Educator's Details
Name
*
First Name
Last Name
Dayhome Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Mobile Number
*
Please enter a valid phone number.
Date of Birth
*
-
Month
-
Day
Year
Date
Childcare Level / Certificate No.
Do you have a clear Criminal Record Check dated within the last 6 months?
Please Select
Yes
No
If YES, Date of Criminal Check taken/conducted
Do you have a valid Childcare First Aid and CPR certificate?
Please Select
Standard First Aid
Childcare First Aid
No
Is your Dayhome?
Private
Approved and Licensed
Date of Expiry
Please list down all languages spoken
Dayhome Details
How many people reside in the home (18 and above)?
Adults (18 years old and above)
How many people reside in the home (Youth/Children)?
Youth / Children
Please list down all their full names, ages, and occupation below. Indicate whether a person is a smoker or non-smoker.
Last Name, First Name
Ages
Occupation
Smoker / Non Smoker
1
2
3
4
5
6
Do you have any pet/s at home?
No
Yes (If yes, please answer below)
Kind / How many?
Are you currently operating a Dayhome?
No
Yes (If yes, please answer the following)
Hours of operation
Do you provide meals?
No
Yes
No. of children
Children’s ages
What type of house do you live in?
House
Duplex
Townhouse
Apartment
Do you own or rent your house?
What date are you planning to operate your Licensed Dayhome?
-
Month
-
Day
Year
Date
Tell us more about yourself and your family
Are you comfortable providing care for children with special needs?
No
Yes
Why are you interested in joining Calgary Children Family Dayhome Agency?
Submit
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