This form is to collect some information that is required to initiate the fee subsidy application process.

*IMPORTANT*

DO NOT fill out this form if:
- you require child care for special needs ONLY, please contact your referring agency or health practitioner.
- you are in current receipt of Ontario Works AND are working or in school. Contact your Employment Resource Worker to discuss your child care needs.

You MUST have a confirmed child care spot to proceed with this child care fee subsidy pre-assessment.