Early Childhood Education Questionnaire
Please be advised that all information provided here is strictly confidential and used for the sole purpose of determining your eligibility for our programs.
What is your name? *
Parent Name
Your answer
What is your address? *
Your answer
What is your phone number? *
Your answer
What is your child or children's name(s)? *
Your answer
Child(s) date of birth? *
Your answer
Has your child participated in any other Early Childhood setting? *
For example: pre-school, day care, play groups etc.
What determines your need for care? *
What program are you applying for? *
If you are unsure that is ok.
Do you currently have an open case with HRA or ACS?
Do you have a Case Worker? *
If so, what is there name and contact info?
Your answer
Are you currently employed? *
Are you on Public Assistance? *
If so what types?
Required
How did you hear about us? *
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