Registered Childminder Membership Form

Where did you hear about Childminding Ireland?

Your Name (required)

Your Address (required)

Your Email (required)

Phone (and area code):

Mobile:

Date of Birth

FemaleMale

Nationality

How many Children do you mind?
1234 or more
Full Time (Preschool)AfterschoolPart Time (Preschool)

I agree that

We keep the following family pets

Sharing Your Details
Please Circle Y/ N

To enable effective marketing of your service to parents seeking quality local Childminding places and to facilitate local Childminder Support, please indicate your agreement to the following :

I agree to have my contact details shared with other members in my area:YesNo

I agree that my contact details will be provided to parents seeking a Childminder in my area:YesNo

I agree to advertise my Childminding service on www.childminding.ieYesNo

I have completed the process set out for Voluntarily NotificationYesNo

Declarations for Registered Childminder Membership Insurance

Have you:

(A) Ever been declared bankrupt or insolvent?YesNo

(B) ever been convicted or charged, (but not yet tried), with a
criminal offence other than a minor motor offence?YesNo