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Childcare Provider Registration Form
Subscription Details
You are registering for our "Best Value Package" for $19.95/year... good choice!
Childcare Information
Childcare Name:
* Required
Childcare Description:
Website Address:
* Please enter a valid web address (http://www.yoursite.com)
Age Group:
Birth
6 months
12 months
18 months
24 months
30 months
3 years
4 years
5 years
School age
To:
Birth
6 months
12 months
18 months
24 months
30 months
3 years
4 years
5 years
School age
Total Spaces:
* Please enter a value between 0 and 100
* required
Available Spaces:
* Please enter a value between 0 and 100
*Available spaces must be less than or equal to total spaces
* required
Childcare Contact Details
Childcare Email Address:
* Daycare Email Required
* Please enter a valid email address
Phone Number:
* Daycare Phone Number Required
* Please enter a valid phone number
Extension:
Childcare Address
Street Address or Nearest Cross Streets:
Suite (if applicable):
City:
*required
Province:
*please select a province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
[ CHOOSE ]
Postal Code:
*required
*invalid Canadian postal code
*must be in XXX XXX format
Login Information
First Name:
* Required
Last Name:
Email:
* Required
* Please enter a valid email address
Password:
* Required
* Passwords do not match.
Password Confirm:
Hours of Operation
If your daycare is not open during one of the says, select zero(0) for the open and close hour for that day of the week.
Open
Close
Monday
0
1
2
3
4
5
6
7
8
9
10
11
12
:
00
15
30
45
AM
PM
0
1
2
3
4
5
6
7
8
9
10
11
12
:
00
15
30
45
AM
PM
Tuesday
0
1
2
3
4
5
6
7
8
9
10
11
12
:
00
15
30
45
AM
PM
0
1
2
3
4
5
6
7
8
9
10
11
12
:
00
15
30
45
AM
PM
Wednesday
0
1
2
3
4
5
6
7
8
9
10
11
12
:
00
15
30
45
AM
PM
0
1
2
3
4
5
6
7
8
9
10
11
12
:
00
15
30
45
AM
PM
Thursday
0
1
2
3
4
5
6
7
8
9
10
11
12
:
00
15
30
45
AM
PM
0
1
2
3
4
5
6
7
8
9
10
11
12
:
00
15
30
45
AM
PM
Friday
0
1
2
3
4
5
6
7
8
9
10
11
12
:
00
15
30
45
AM
PM
0
1
2
3
4
5
6
7
8
9
10
11
12
:
00
15
30
45
AM
PM
Saturday
0
1
2
3
4
5
6
7
8
9
10
11
12
:
00
15
30
45
AM
PM
0
1
2
3
4
5
6
7
8
9
10
11
12
:
00
15
30
45
AM
PM
Sunday
0
1
2
3
4
5
6
7
8
9
10
11
12
:
00
15
30
45
AM
PM
0
1
2
3
4
5
6
7
8
9
10
11
12
:
00
15
30
45
AM
PM
Image Uploads
Click the "Browse" button to select your saved image.
Image 1
File Path:
* Please choose an image with a .jpg extention.
Image Caption:
Image 2
File Path:
* Please choose an image with a .jpg extention.
Image Caption:
Image 3
File Path:
* Please choose an image with a .jpg extention.
Image Caption:
Image 4
File Path:
* Please choose an image with a .jpg extention.
Image Caption:
Image 5
File Path:
* Please choose an image with a .jpg extention.
Image Caption:
Image 6
File Path:
* Please choose an image with a .jpg extention.
Image Caption:
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