Home Child Care Provider Application

* = Required

Contact Information

Check the following statements that apply:

Household Information

* Residential status

Household Composition

List all adults and children in your household. They may be a part of the interview process.

+ Add a family member

List all adults (over 18) who may be visiting the home during the hours of care:

+ Add a visitor

Service Information



Preferred Age Range of Children

As governed by the regulations set out under the Child Care and Early Years Act, 2014 and Niagara Region policies, any Home Child Care Provider who is affiliated with a Licensed Home Child Care Agency, may have up to six children in care at any one time. Below you will see a breakdown that outlines the total number of children per age group permitted in care at any one time:

  • No more than six children in care under the age of 13 years, including the Home Child Care Provider's own children under the age 4 years
  • No more than three children under the age of 2 years


References can be a friend, a neighbour, family member (not including someone you live with) previous employer.

Reference 1

Reference 2

Reference 3

Reference 4

Terms and Conditions

I understand that:

Applications will be kept on file for six months. It is the responsibility of the applicant to ensure that their application is renewed after the six month period.

Notice of Collection

Any personal information or personal health information submitted will be collected, used, and disclosed, where applicable, by members of Regional staff according to the Municipal Freedom of Information and Protection of Privacy Act or the Personal Health Information Protection Act. Any information you share will only be used for the intended purpose for which it was provided.

For questions or comments about privacy practices, or for more information about the administration of the Municipal Freedom of Information and Protection of Privacy Act in Niagara Region programs, see Freedom of Information and Open Government.

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