https://weewatch.com/provider-portal/#1638820116070-0b161e71-5c1d 

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Application for Childcare Enrollment PARENT/GUARDIAN INFORMATION Parent/Guardian 1 First Name:*   Parent/Guardian 1 Last Name:* Address:*                        Unit City:*                           Postal Code:* ___ ___ Home Phone:                     Province: Select Work Phone:                     Cell Phone:* Email:*                          Gender: Male   Female   Other Relationship to Child:* Please select Employer Name/City:* Parent/Guardian 2 First Name:   Parent/Guardian 2 Last Name: Same address as Parent 1       Address: Address:                        Unit City:                           Postal Code: Home Phone:                     Province: Select Work Phone:                     Cell Phone: Email:                          Gender: Male   Female   Other Relationship to Child: Please select Custody Arrangements (if applicable): Are you subsidized or applying for childcare subsidy?:* Yes   No Languages spoken at home: CHILD INFORMATION Child’s First Name:*            Child’s Last name:* Gender:* Male   Female   Other Date of Birth:* Child’s Home Address: Same as Parent 1   Same as Parent 2 Address:                        Unit City:                           Postal Code: Province: Select Names/ages of siblings (note: a separate application must be completed for each child): Name and Location of Child’s school (if applicable): General Health: Any known allergies, health or medical conditions?* Yes   No If yes, please describe:* Does your child require any special food or liquids or any special diet?* Yes   No If yes, please describe:* Please indicate preferred area for daycare, and outline any additional comments or requirements regarding the care of your child: SCHEDULE AND LOCATION Date childcare required:* Days of the week child needs to be in care:* Please indicate care required:* Hours each day child needs to be in care:* Days   Evenings   Weekends   Overnights   Start Time:*   End Time:*   Varied Hours:* Days and Hours of the week Parent 1 works: Closest intersection to home:* Closest intersection to work:* Days and Hours of the week Parent 2 works: Closest intersection to home (Parent 2): Closest intersection to work (Parent 2): PREFERENCES What is most important to you in selecting a childcare Provider?:* Are you open to place your child with a Provider with pets?* Yes   No How did you hear about Wee Watch? Friend/Family   Google   Facebook/Instagram   Print ad   Radio   Other   Describe PHYSICIAN AND EMERGENCY CONTACTS Physician’s Name:* Phone Number:* Persons to contact in an emergency if parents cannot be reached, and to whom the child may be released: Full Name:* Phone #:* Relationship: Full Name:* Phone #:* Relationship: Full Name: Phone #: Relationship: SIGNATURES Signature of Parent/Guardian:* Date: The agency will contact you to discuss your needs, answer your questions and advise you of the registration fee

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