Children Information for Child Care Subsidy


Applicant Information

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Children Information

Child's Last Name
(no more than 25 characters)
Child's First Name
(no more than 20 characters)
Is this child attending Grade 1 - 6? Yes No
Birthdate (yyyy/mm/dd)
Set this date (click to open the Calendar).
Estimated Hours of Care needed per month
Estimated Costs ($per month)
How many hours of care are needed outside regular business hours 6:00 am to 6:00 pm?
Are you applying for Kin Child Care (which is a relative over 18 not residing with you that provides child care)? Yes No

City/Town child is receiving care atFor quick selection enter the first characters of a City/Town's name in the following field:

Type of Service Provider
Service ProviderFor quick selection enter the first characters of a facility's name in the following field:

Start Date (yyyy/mm/dd)
Set this date (click to open the Calendar).
Is this child attending more than one Day Care/Family Day Home? Yes No