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.
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What is your name? *
Parent Name
What is your address? *
What is your phone number? *
What is your child or children's name(s)? *
Child(s) date of birth? *
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?
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Do you have a Case Worker? *
If so, what is there name and contact info?
Are you currently employed? *
Are you on Public Assistance? *
If so what types?
Required
How did you hear about us? *
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