"Child Care Facility Registration & Food Establishment Permit Application" - Nova Scotia, Canada

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Download "Child Care Facility Registration & Food Establishment Permit Application" - Nova Scotia, Canada

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Child Care Facility Registration
& Food Establishment Permit Application (if applicable)
Agriculture
I (We) hereby apply to register a Child Care Facility with the Department of Agriculture,
Food Protection and Enforcement Division, and provide the following information.
The information contained in this application may be subject to public release.
1 Give contact information
(This will be used as return mailing address information.)
Reset 1
Contact/owner name:
Mailing address:
City/Town:
Prov.:
Postal code:
Telephone:
Cell:
Fax:
Email address:
2 Give facility details
(For more information on temporary events, please visit our website at
Reset B
www.novascotia.ca/agri/foodsafety
)
Facility name:
Business address (Civic #):
Street:
Town:
Registered Business #:
N
S
(required)
Start date:
(To
register a
business, please visit Service Nova Scotia at
www.gov.ns.ca/snsmr/access/business/ready-register-business.asp
)
Proposed Program:
Full day (over lunch)
Part day (not over lunch)
Both full day and part day
Days of Operation
Age Range
Proposed # of Children
Monday to Friday
Thursday
Infants (0-17 months)
Monday
Friday
Toddlers (18-36 months)
Tuesday
Extended hours
Preschools (36 months – 5 years)
Wednesday
(Saturday, Sunday and evenings)
School age (5+)
Total number of children =
3 Sign application
Signature of Applicant
Date
4 Return completed form to
Nova Scotia Department of Agriculture
PLEASE NOTE: In the event of owner change or business
Agriculture and Food Operations:
location change this permit is not transferable and a new
permit must be applied for. 
Food Protection and Enforcement
PO Box 890 (Harlow Institute)
Truro, NS B2N 5G6
Questions?
Call toll-free 855-893-5309 or
902-893-5311(Truro) • Fax: 902-896-2381
March 2013
Child Care Facility Registration
& Food Establishment Permit Application (if applicable)
Agriculture
I (We) hereby apply to register a Child Care Facility with the Department of Agriculture,
Food Protection and Enforcement Division, and provide the following information.
The information contained in this application may be subject to public release.
1 Give contact information
(This will be used as return mailing address information.)
Reset 1
Contact/owner name:
Mailing address:
City/Town:
Prov.:
Postal code:
Telephone:
Cell:
Fax:
Email address:
2 Give facility details
(For more information on temporary events, please visit our website at
Reset B
www.novascotia.ca/agri/foodsafety
)
Facility name:
Business address (Civic #):
Street:
Town:
Registered Business #:
N
S
(required)
Start date:
(To
register a
business, please visit Service Nova Scotia at
www.gov.ns.ca/snsmr/access/business/ready-register-business.asp
)
Proposed Program:
Full day (over lunch)
Part day (not over lunch)
Both full day and part day
Days of Operation
Age Range
Proposed # of Children
Monday to Friday
Thursday
Infants (0-17 months)
Monday
Friday
Toddlers (18-36 months)
Tuesday
Extended hours
Preschools (36 months – 5 years)
Wednesday
(Saturday, Sunday and evenings)
School age (5+)
Total number of children =
3 Sign application
Signature of Applicant
Date
4 Return completed form to
Nova Scotia Department of Agriculture
PLEASE NOTE: In the event of owner change or business
Agriculture and Food Operations:
location change this permit is not transferable and a new
permit must be applied for. 
Food Protection and Enforcement
PO Box 890 (Harlow Institute)
Truro, NS B2N 5G6
Questions?
Call toll-free 855-893-5309 or
902-893-5311(Truro) • Fax: 902-896-2381
March 2013