Therapeutic Referral for Child Care - London Ontario - london 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Parent Information' section. Include the full names and dates of birth for both custodial parents or guardians.
3. Next, provide details for each child requiring subsidized care in the 'Child Information' section, including their full names and dates of birth.
4. Complete the 'Family Information' section with your address, city, province, postal code, and phone number.
5. In the 'Referral Information' section, enter details about the referral agency and the person providing the referral. Specify contact information and check all applicable reasons for referral.
6. Use the additional notes section to elaborate on any emergency situations if applicable. Indicate how many days of care are recommended per week.
7. Finally, ensure all signatures are obtained from both parents/guardians and the referring professional before submitting your completed form.

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