Educator Sign-Up Enquiry

What is your address?

Note: When you start typing, the address will autocomplete.

List the name(s) and age(s) of children 13 years and under living in the home (one per line):

List other residents of your household including spouse (one per line):

Type of Home:

For your Home do you:

Note: All rental properties require written permission from their landlord in order to operate a day home.

Do you have a fully fenced and gated yard?

Do you have a space to set up a playroom for the children?

Do you smoke?

Do you have any pets?

If you have pets, what kind do you have?

Are you available to care for children Monday through Friday from 7:00 am to 6:00 pm? If not, please explain:

How many children do you wish to care for?

What area of your home will be used for the children’s play space?

Is there a window in the space that provides natural light?

Describe the type of activities you will provide for children?

What form of guidance will be used in your day home?

Please list any previous child care experiences you have:

Please list any formal training in Early Childhood Development you have:

How did you hear about our Agency?

Do you have any additional questions or comments?