Shooting Stars Day Home: Intake Request Form
Thank you for contacting Shooting Stars Licensed Family Day Home. As I am a family day home educator operating under a licensed agency, my clients are able to access the government grants and subsidy. (If you qualify.)

Please fill out the form below if you would like more information about my day home, are interested in an interview or would like to be added to my waitlist. I strive to rely to all responses as soon as possible but please be advised that it may take up to 72 hours for a response or longer if the forms are submitted on a weekend.
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Email *
Your name: *
How many children do you require care for? *
What are your child(ren)'s birthdate?
(This is to confirm their age is within ratio)
Your ideal/preferred care schedule?
(Ex: How many days per week, what days per week and if you require the same schedule each week or if it changes, etc.)
What are the hours of care you require? 
(Estimate of drop off and pick up times)
When are you looking to start care? *
Please tell me a little about your children and their personalities *
Do your children have any allergies, intolerances or dietary restrictions? 
(Please note we are not able to provide a peanut free environment and we do have a Siberian Husky Dog)
What are you looking for in a day home?  *
Is there anything else not mentioned above that you would like me to know? *
If I do not have any current space available, would you like me to add you to my waitlist? 
Thank you for your interest in my day home! We will be in touch soon!
A copy of your responses will be emailed to the address you provided.
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