Child Care Provider Registration Form Page 2
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1
2Child Care in the province of Ontario is regulated under the recently implemented Child Care and Early
Years Act, 2014. You can review the changes to child care legislation at the Government of Ontario’s
website:
Have you reviewed the changes to legislation and are now aware of the Child Care and Early Years Act
regulations for licensed as well as unlicensed Home-Based Child Care? _________________
Preferred ages of Children:
Care Environment:
Under 1 year Y_____ N _____
______Do you smoke?
1-2 years old Y_____ N _____
______Is there a smoker living in your home?
2-4 years old Y_____ N _____
______Do you have pets in your home?
5 yrs & over
Y_____ N _____
______Annual vaccinations for pets?
Will you care for children with special needs?
__
____
Do you have access to a vehicle?
______Do you have car/booster seats?
Additional Information:
Peterborough Family
Resource Centre Services:
______ Fire inspection of home?
Have you participated/accessed:
Drop-In Programs_______
______ Police check if requested?
Toy & Book Library _______
______
Child Care Liability insurance added to your home insurance policy?
Caregiver Workshops_______
______ Do you provide parents with a written child care agreement?
Caregiver Newsletter _______
Description of your service:
( i.e. crafts and games, large playroom, field trips, parks near by, etc…)
Child Care Fee Schedule:
Extended hours/ Alternative Child Care
Fees:
Infant Care:
__________
____________
full day
1/2 day
________________________________________
Toddler Care:
__________
____________
full day
1/2 day
________________________________________
Preschool Care:
_________
____________
full day
1/2 day
________________________________________
School Age Care:
____________________
Before & after
____________________
Before or after
**This information will be used for bi-annual caregiver survey
I have read and understood the guidelines, and I have signed the agreement for the use of the Child Care
Information Exchange. I hereby certify that the information in this document is true, correct and complete.
I agree to inform the Child Care Information Exchange of any changes in my information or status of my
service.
Signed
Date
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