Location

City/Town:
Street Name: (Enter the street name of the centre or agency office)
Postal Code:(Enter the 6 characters of your postal code)	(Enter the 6 characters of your postal code)
Located in a Public/Catholic School:	Located in a Public/Catholic School: .
This field only applies child care centres.

Your Child Care Needs

Type of Program:	Type of Program:  Child Care Centre    Home Child Care Agency
Age Group: This field only applies child care centres.	Age Group:  Infant (Under 18 months)  Toddler (18 months up to 30 months)  Preschool (30 months up to 6 years)  Kindergarten (44 months up to 7 years)  Primary/Junior School Age (68 months up to 13 years)  Junior School Age (9 years up to 13 years)  Family Age Group (Under 13 years)
Language of Service:	Language of Service:  English    French	Language of Service:Other

For a Specific Program

Name of Child Care Centre/Home Child Care Agency: