Wise Kids House Parent/Guardian Application

Parent/Guardian

First Parent

Relation to child *

Full Name *

Email *

Phone *

I agree to terms & conditions provided by the company. By providing my email address and phone number, I agree to receive email and text messages from the business. *

I agree

Address *

Work Phone *

Work Address *

Alternative Address

Second Parent

Relation to child *

Full Name *

Email *

Phone *

I agree to terms & conditions provided by the company. By providing my email address and phone number, I agree to receive email and text messages from the business. *

I agree

Address *

Work Address *

Work Phone *

Alternative Address

Enrolment

Date of Request *

When care is needed *

Types of Care *

Full Time (3-5 Days)

Part Time (1-2 Days)

School Age

Transportation Needed

Pets in the provider's home? *

Yes
No
No elements found. Consider changing the search query.
List is empty.

If no, indicate why.

Special Requirements?

Child 1 Information

Full Name *

DOB *

Gender *

Full Time or Part Time? *

Full Time (3-5 Days)

Part Time (1-2 Days)

Hours Required *

Currently in care? *

Yes
No
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Immunizations up to date? *

Yes
No
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Toilet trained? *

Yes
No
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Child 2 Information

Full Name

DOB

Gender

Full Time or Part Time?

Full Time (3-5 Days)

Part Time (1-2 Days)

Hours Required

Currently in care?

Yes
No
No elements found. Consider changing the search query.
List is empty.

Immunizations up to date?

Yes
No
No elements found. Consider changing the search query.
List is empty.

Toilet trained?

Yes
No
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List is empty.

Subsidy (Only for School-aged Children)

Check one that applies. *

Subsidy is approved.

I have applied for Subsidy.

I will apply for Subsidy.

I need help for applying for Subsidy.

I do not plan to apply for Subsidy.

- If Subsidy is approved,

Confirmation #
$ Amount

- If applied for Subsidy,

Living Arrangements

Child lives with *

Mother

Father

Other

Is there a custody agreement? *

Yes
No
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School

Please select one that applies as you expect them to be on your child's start date *

Choose one

Not in school
Attending Kindergarten
Attending in Gard 1 - 6
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List is empty.

School Name:

Referral Source

Where did you hear about Wise Kids House? *

The day home name that you have contacted (if you have)

SUBMIT