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Intake Eligibility Form – Emergency School-Age Care (Wellington & Guelph)

Only complete this form once you have confirmed a child care space with one of the approved Emergency Child Care programmes

Emergency Child Care is being offered at no cost to eligible families during the week of January 4 – 8. To be eligible, the parent, or both parents in a two-parent home, need to be actively working during this time with at least one parent working in an occupation included on the list of Workers Eligible for Emergency Child Care

Proof of employment as an eligible worker must be submitted along with this form. Proof can be in the form of a paystub, ID badge from work, letter of employment.

Once requested information is provided, the County of Wellington will notify the child care programme that you are eligible to use care. Programmes will not provide care to your child unless given approval to do so by the County of Wellington.

Parent/Guardian Information

Parents/Guardian Name(s)

Parent/Guardian 1

Parent/Guardian 2


Home Address


Contact Information


Employment Information

Parent/Guardian 1

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Parent/Guardian 2

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Privacy Notice

Personal information (PI) is collected under the authority of the Municipal Act, 2001. All personal information created, held or collected by the County of Wellington is protected in accordance with Municipal Freedom of Information and Protection of Privacy Act, 1990 (MFIPPA). For questions related to this collection of personal information, contact the Manager of Privacy and Information, County of Wellington, Office of the CAO, T 519.837.2600 x2522.



© 2020 County of Wellington, 74 Woolwich St. Guelph, Ontario N1H 3T9, T 519.837.2600, TF 1.800.663.0750, F 519.837.1909