Please provide a copy of your child’s immunization record (e.g., yellow card) to the agency prior to your child’s first day of care. If you do not have an immunization record, please fill in the chart below.
If you have chosen not to immunize your child, a Statement of Medical Exemption form or a Statement of Conscious or Religious Belief form must be completed and provided to the agency. These forms are available on the Ministry of Education’s website.
*For children under 12 months, please complete, Appendix A: Supplementary Information for Children Under 12 Month.
*For children under 12 months, please also complete, Appendix A: Supplementary Information for Children Under 12 Months.
Note: ‘Parent’ is defined as a person having lawful custody of a child or person who has demonstrated a settled intention to treat a child as a child of his or her family, and includes legal guardians.
Note: According to the Joint Statement on Safe Sleep: Preventing Sudden Infant Deaths in Canada, children up to their first birthday will be placed on their backs for sleep. This has been Health Canada’s recommendation since 1993, as a means to reduce the risk of Sudden Infant Death Syndrome (SIDS)2
The requirement for an infant sleep position may only be waived if a medical doctor/physician recommends differently in writing.
Understand that:
Note: Consider adding the brand name of the non-prescription items for transparency.
I give permission for my child to be photographed while attending childcare and for permission to use in promotional materials
This childcare will respect the confidentiality between the agency and the families childcare is provided for. Information regarding parents and their children will be held in the strictest confidence both during and after the provision of childcare services. It is necessary for you to feel free to confide in your provider in order to maximize benefits to all involved. Parents will also be held to strict confidentiality regarding other families in the provider’s care. Making false or damaging statements about this childcare, the provider or other families in care will result in immediate termination of this contract and may be actionable in a court of law.
I authorize to administer over the counter medications provided by me to my child as instructed by me in writing, in accordance with the label, as needed. Children’s fever reducers i.e. Tylenol, Advil generic brand.
As part of my child enrollment agreement, I am obligated to give 2 WEEKS Notice for my Child to Withdraw/End care agreement with MURFAT HOME DAY CARE.
The parent agrees to comply with the parent handbook of MURFAT HOME CHILD CARE that will be provided to the parents after the completion of the Application process.
Murfat Home Child Care (MHCC) is proudly enrolled in the Canada-Wide Early Learning and Child Care (CWELCC) system under the Ontario Ministry of Education. Our 2025 rates reflect the new provincial fee cap of $22 per day for all eligible children under 6 years of age. These rates are designed to make high-quality, licensed home child care affordable while maintaining the highest standards of safety, education, and nurturing care.
72(1) Every licensee shall ensure that up-to-date records are kept of the following matters in respect of each child receiving child care at a child care centre operated by the licensee or receiving child care at a premises where it oversees the provision of home child care:
Disclaimer: This document is a sample template that has been prepared to assist licensees in understanding their obligations under the CCEYA and O. Reg. 137/15. It is the responsibility of the licensee to ensure that the information included in this document is appropriately modified to reflect the individual circumstances and needs of each home child care agency it operates and each premises where the licensee oversees the provision of home child care.
Please be advised that this document does not constitute legal advice and should not be relied on as such. The information provided in this document does not impact the Ministry’s authority to enforce the CCEYA and its regulations. Ministry staff will continue to enforce such legislation based on the facts as they may find them at the time of any inspection or investigation.
It is the responsibility of the licensee to ensure compliance with all applicable legislation. If the licensee requires assistance with respect to the interpretation of the legislation and its application, the licensee may wish to consult legal counsel.