Childcare Questionnaire

Family Information:

Family Name:
His:
Her:
Address:
Postal Code:
Home Phone:
Email:
Business Her #:
Fax Her #:
Cell Her #:
Occupation (Her):
Travel with job (Her):
Overnights away from home (Her):
Weekend Employment (Her):
Shift Work (Her):
Emergency Contact (Her):
Business His #:
Fax His #:
Cell His #:
Occupation (His):
Travel wih job (His):
Overnights away from home (His):
Weekend Employment (His):
Shift Work (His):
Emergency Contact (His):

Child 1:

Name:
DOB:
Age:

Child 2:

Name:
DOB:
Age:

Child 3:

Name:
DOB:
Age:

Child 4:

Name:
DOB:
Age:

Child 5:

Name:
DOB:
Age:

Child 6:

Name:
DOB:
Age:

Are there any other adults living within the home:

Childcare Requirements:

Children's special interests or medical needs:
Do you smoke:
Family Pets:
Is driving required: Yes
No
Will a car be provided: Yes
No
Duties required; please describe:

Nursery Details:

Laundry:
Clean/Tidy Bedrooms:
Bathroom:
Play Areas:
Closets:
Prepare Breakfast:
Prepare Lunch:
Prepare Snacks:
Commence Family evening meal Monday - Thursday:
 

Live-In:Employer is responsible, should they reside on a city acreage or outside city limits or there is no regular bus service, to transport their Nanny to/from the nearest City Bus location. Nanny's attend their ethnic church service within the city and often stay over the weekend within their community. This offers the Nanny social ethnic contact and assists with their settling in Canada.

For an overseas caregiver: please write a letter of introduction to your prospective caregiver and enclose pictures of the children/family.
We're a Member of the Canadian Coalition for In-home Care
For information on legislation & regulations governing In-home care in Canada visit CCIHC
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