Support Professionals in RayCam Cooperative's Childcare Spaces
Name of Professional Visiting
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First Name
Last Name
Organization's Name
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Work Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of child you will be visiting
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First Name
Last Name
Which childcare program will you be visiting at RayCam Cooperative Centre?
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Daycare
Out of School Care
Purpose of visiting childcare space
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Please include reason for why it is essential to meet in the childcare space, rather than meeting at a child's home, non-childcare space at RayCam, clinic, etc.
Please list the dates/ frequency of visits
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Please attach copy of parental/guardian consent.
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If your organization does not have their own consent form for the visit, please ask the parent/guardian to fill out "Supporting Professional Parental Consent" on the website.
Cancel
of
Please provide information about the extent of interaction/observation you anticipate with other children in the room.
*
Does your organization maintain criminal record clearance as condition of employment?
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Yes
No
Please detail what support you require from childcare staff for your visit.
*
Please confirm that you will not be using any recording device (audio, video or photographs) during your visit at RayCam Cooperative Association.
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I confirm
Please confirm that you will not be leaving any notes or messages to be passed on to the family after the visit.
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I confirm
Please confirm that you understand that filling out this form does not automatically grant you access to childcare space. A staff member will reach out to you and the parent/guardian confirming that the visits can be accommodated.
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I confirm
Signature
*
Date
*
-
Month
-
Day
Year
Date
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