Eeyou Education - Emergency Childcare Services Form

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Application Form

Please note: Completion of the form does not guarantee services. Following the review of your information a communication will be sent regarding your eligibility for services. (One form per child)

Child's Information

First Name of the Child(*)

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Last Name of the Child(*)

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Child's Age

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Child's Health Insurance Card Number

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Community(*)

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Additional information on the particular needs of the child

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Additional information regarding any medical condition of the child

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Parent(s)/Guardian(s) Information

This service is for essential workers only.

Parent/Guardian 1

Name of Parent/Guardian 1(*)

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Profession 1(*)

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Supervisor Name 1(*)

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Supervisor Contact Information 1(*)

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Parent/Guardian 1 currently teleworking(*)

Yes No

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Are you a single parent?

Yes No

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If not, are both parents/guardians essential workers?

Yes No

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Parent/Guardian 2

Name of Parent/Guardian 2

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Profession 2

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Supervisor Name 2

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Supervisor Contact Information 2

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Parent/Guardian 2 currently teleworking

Yes No

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Email Address(es)

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Phone number(s)(*)

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People authorized to pick up the child

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Additional person to contact in case of emergency(*)

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Services required and child's pickup times

Monday

AM Lunch PM

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Tuesday

AM Lunch PM

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Wednesday

AM Lunch PM

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Thursday

AM Lunch PM

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Friday

AM Lunch PM

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Comments

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(*)

I confirm that I will bring a letter from my employer stating that I am an essential worker the first time I drop of my child at the emergency childcare services. I understand that if I am unable to provide such a letter my child will not be eligible for the services and will not receive childcare services until such a letter is provided. (*)

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(*)

I confirm that there is no alternate care available for my child (*)

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Covid-19 - Emergency Childcare Services 2021

Application Form

Child's Information

Parent(s)/Guardian(s) Information

Parent/Guardian 1

Parent/Guardian 2

Services required and child's pickup times

Cree School Board

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