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Fee Subsidy Confirmation of Space Form
Fee Subsidy
Confirmation of Space Form
Please complete this form when placing a child whose parent/guardian has requested Child Care Fee Subsidy.
This information is collected under the legal authority of the Child Care and Early Years Act, 2014 for administering the programs and services prescribed or authorized under this Act.
Yes, I give permission to store and process this data
Child Care Site Information
Name of Child Care Centre/Site
Name of Staff completing the form
Email of staff completing the form
Parent Information
Parent/Guardian Name
How many children are being placed?
1
2
3
4
Child 1
Name
DOB
Effective Start Date
Program Age Category
Infant
Toddler
Preschool
JK/SK
School Age
Family Grouping
Care Times Required (check all that apply)
Before School
After School
PD Day
Breaks
Care Days Required (check all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
According to work schedule
Child 2
Name
DOB
Effective Start Date
Program Age Category
Infant
Toddler
Preschool
JK/SK
School Age
Family Grouping
Care Times Required (check all that apply)
Before School
After School
PD Day
Breaks
Care Days Required (check all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
According to work schedule
Child 3
Name
DOB
Effective Start Date
Program Age Category
Infant
Toddler
Preschool
JK/SK
School Age
Family Grouping
Care Times Required (check all that apply)
Before School
After School
PD Day
Breaks
Care Days Required (check all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
According to work schedule
Child 4
Name
DOB
Effective Start Date
Program Age Category
Infant
Toddler
Preschool
JK/SK
School Age
Family Grouping
Care Times Required (check all that apply)
Before School
After School
PD Day
Breaks
Care Days Required (check all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
According to work schedule
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