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Child Care Registration

If you are inquiring about a childcare space in one of our centres we ask that you complete the availability request form below.

Initial Request for Childcare


Child's Information

Name (First, Last)*:

Date of Birth*:

/ / MM / DD / YYYY

Gender: Male Female

Address:


Street Address


Address Line 2


City / Province

CANADA
Postal Code


Parent/Guardian Information

Parent One

Name (First, Last)*:

Email*:

Home Tel*: ( ) ext:

Bus/Cell: ( ) ext:

Parent Two

Name (First, Last):

Email:

Home Tel: ( ) ext:

Bus/Cell: ( ) ext:

 

Childcare Details

Location*:

Program*:

 

Days: (check all that apply)

Monday

Tuesday

Wednesday

Thursday

Friday

 

Duration of Care:

Full Day

Half Day

Before/After Care

 

Desired Enrollment Date*:

/ / MM / DD / YYYY


How did you hear about us?:

If 'Other' please describe:

 

Comments/Additional Info:



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