Essential Services Worker Child Care Request Form

For the purposes of this form and program, priority will be given to critical service workers in health care. Other critical services workers identified for this program include:

  • Emergency Service Providers - Healthcare
  • Corrections Workers
  • Law Enforcement
  • Fire and Paramedic
  • Direct Social Services and Child Protection Workers
If you are an critical services worker who cannot make alternate care arrangements and require care in order to respond to COVID-19, please complete and submit this form. You will be contacted by the Early Learning and Child Care Program.

IMPORTANT: If you have already provided this information to your child care provider or phoned Early Learning and Child Care do not complete and submit this form. We will reach out to you.

Primary Applicant (required)
Primary Applicant's Full and Legal Name:
Primary Applicant's Address:
Primary Applicant's Place of Work (if essential services worker)
Secondary Applicant (optional)
Secondary Applicant's Full and Legal Name:
Secondary Applicant's Address (if different than primary):
Secondary Applicant's Place of Work (if essential services worker)
Child Information (under 12 years of age)
Child #1
Child #2
Child #3
Child #4
Child #5