Waiting List Placement Registration

Start Date

Name

First

Last

Layout

Email Address

Home Phone Number

Cell Phone Number

Home Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Layout

Child Name 1

Child Birthdate 1

Child Name 2

Child Birthdate 2

Child Name 3

Child Birthdate 3

Care Required

Full Time
Part Time

If part time, do you require:

Any days
Monday/Wednesday/Friday
Tuesday/Thursday

Please specify care required

Layout

Child Arrival Time

Departure Time

Parent's Name

Parent's Work Phone Number

Parent's Name

Parent's Work Phone Number

Method of Payment

Fee Paying
Subsidized: Full
Partial

How did you hear about our Centre?

Tour?

Yes
No

Comments/ Questions

Note: The waiting list will be maintained in a manner that protects the privacy and confidentiality of the children and families on the list and therefore only the child’s position on the waiting list will be provided to parents. Names of other children or families and/or their placement on the waiting list will not be shared with other individuals.

Child Care Registration

Waiting List Form Submission

Request for Waiting List Placement