Provider Waitlist form - High5 Daycare

Provider Form

First Name

Please provide your first name.

Last Name

Please provide your last name.

Gender

Please enter your gender.

Date of Birth

Please enter your date of birth.

Address

Please provide your address.

Unit

Please provide unit.

City

Please provide your city .

Province

Please provide your province.

Postal Code

Please provide your postal code.

Phone Number

Please provide your phone number.

Cell Phone

Please provide your cell number.

Email Address

Please provide your email.

Years at this address

Please provide your years at this address.

Reason why you want to provide home daycare?

Please provide your reason why you want to provide home daycare.

Describe any childcare experience

Please provide your childare experience.

Are you currently running a daycare at your home?

Yes

List other work experience

Please list other experience?.

Are you a Registered Early Childhood Educator (RECE)?

Yes

Do you have a Standard First Aid certificate and CPR Level C?

Yes

How did you hear about us?

Please provide hear about us?.

What is your home type?

Please provide your home type?.

Ownership

Please select ownership?.