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AD40 Additional Child Care Provider or Children Form

If you are applying for the Childcare Subsidy, use this form to fill out any additional children that there was not space for in the original form. You can find the original form here.

Applicant Name

Child information

Please attach a copy of your child's Birth Certificate

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Child's Name

Child's Birthday

Name of Child Care Provider

Address

Legal Land Location

Rural Address

Phone Number

Email Address

Relationship of Child Care Provider to Child

Estimated monthly hour of care need

Estimated monthly cost of care

Start Date

Notice of Collection

The personal information on this form is being collected for the purpose of determining eligibility for and administering Saddle Hills County's Childcare Subsidy and will be shared with Administration. The information is collected under the authority of Section 146 of the Municipal Government Act and Section 4 of the Protection of Privacy Act. For questions about the collection of personal information, contact admin@saddlehills.ab.ca or call (780) 864-3760.

Please send me a pdf copy of this form

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