Maisonette Family Dayhome Educator Application Form

Maisonette Family Day Homes

Maisonette Family Dayhome Educator Application Form

First Name *

Last Name *

Email Address *

Mobile Number *

Street Address *

Street Address 2 *

City *

State/Province *

Postal/ZIP Code *

Home Details

Do you own or rent your home? *

Do you smoke inside your home? *

Do you have any pets? *

If yes to having pets at home, please describe:

If yes to having pets at home, please describe: *

Do you have a home security system? *

If yes, to a home security system, please explain:

Household Members

Spouse’s Name (if applicable):

List your own children (names and ages):

List any other children in your care:

List any other people living in your home:

Education & Experience

Describe your background and any relevant child care or education experience: *

Have you ever partnered with a licensed dayhome agency before? *

Do you have any of the following certifications? (check all that apply): *

Child Development Assistant (Level 1)

Child Development Worker (Level 2)

Child Development Supervisor (Level 3)

First Aid / CPR

None

Program & Care Plans Age groups you plan to serve (check all that apply): *

Educational philosophy you intend to offer: *

Montessori

Play-based

Reggio-inspired

Faith-based

No preference/Blended

Languages spoken in your home: *

Inclusive supports you can accommodate (e.g., allergies, sensory needs): *

Referral & Timeline

How did you hear about us? *

If Other please explain:

Dayhome Company Name *

When would you like to open your dayhome? *

Anything Else You’d Like to Share?

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