Educator's Profile Form
To be reviewed by our Childcare Consultant; You will be notified by email once selected.
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.
Format: (000) 000-0000.
Date of Birth
*
-
Month
-
Day
Year
Date
Status in Canada
*
Temporary Resident
Permanent Resident
Canadian Citizen
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
Date of Expiry
Is your Dayhome?
*
Private
Approved and Licensed
Other (Planning to Open a Dayhome)
Reason/s for switching to a new agency. Please specify:
If not applicable type N/A.
Please list down all languages spoken:
Dayhome Details
Please type N/A if "Not Applicable"
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.
Rows
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)
Please specify (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
**If currently running an approved dayhome. Do you provide supplemental fees?
No
Yes
How much do you charge for supplemental fees per child?
Example: $80/child
Number of Registered Children enrolled in your dayhome
Type N/A if Not Applicable
Children’s ages
Please be specific with the ages of your children. Ex. (1 - infant; 3 - preschoolers etc.)
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
*
*Please specify your childcare experience; why you want to open a dayhome; How long have you been in the childcare industry. Include home/family dynamics (if there are adults working from home etc.)
Are you comfortable providing care for children with special needs?
No
Yes
Have you applied or in contact with other Dayhome Agencies?
No
Yes
Why are you interested in joining Calgary Children Family Dayhome Agency?
Submit
Should be Empty: