LCA Childcare Roster Application

Name

Birthdate

This address will receive a confirmation email

Phone

Address

Emergency Contact

Emergency Contact Phone

BC Healthcare Number

Do you regularly attend LCA?

Yes No

Have you completed a Criminal Record Check for LCA within the last three years?

Yes No

Have you reviewed the C&MA Canada's Safety and Risk Assessment brochure with a staff member or Children's Ministry leader?

Yes No

Please list any childcare training and/or experience you may have.

Description

Please fill out this form and click submit. Once your form has been received and reviewed, you will be contacted to either address any unfulfilled requirements or to confirm your addition to the roster.

LCA Childcare Roster Application

Description

Please Fix the Following