The personal information collected on this form is under the authority of the Government Organization Act and managed in accordance with the Freedom of Information and Protection of Privacy Act. The information will be used to determine eligibility for child care subsidy.

If you have any questions about the collection, use or disclosure of this information, please contact the Alberta Supports Contact Centre at 1-877-644-9992 (toll free) or 780-644-9992 (Edmonton Area) between the hours of 8:15AM – 4:30PM, Monday – Friday (except general holidays).



Applicant Information


Are you, your spouse or the child requiring child care a Canadian Citizen or a Permanent Resident of Canada? Yes No


Is your child attending or do you have a reserved placement at any one of the following programs:
  • Licensed Day Care Program
  • Licensed Out-of-School Care Program
  • Licensed Pre-School
  • Approved Family Day Home
  • Approved Early Childhood Program
  • Licensed Group Family Child Care Program
  • Relative child care provider over the age of 18, and does not reside with you?
Yes No


Have you been approved for Subsidy in the past 12 months? Yes No



If you have any questions, please contact the Alberta Supports Contact Centre at 1-877-644-9992 (toll free) or 780-644-9992 (Edmonton Area) between the hours of 8:15AM – 4:30PM, Monday – Friday (except general holidays).