Online Waitlist Application

    • Application Date:
       [None] Select a Date Delete the Date required
      Date of Child Care Required:
       [None] Select a Date Delete the Date required  
      Child's Name:
      required
      Date of Birth (or due date):
       [None] Select a Date Delete the Date required  
      Part-time/Full-time Request:  
       required   
      Name of Parent Applying:  
      Status:  
      required  
       
      Address:
      required
      Postal Code:
        required
      Email Address:
        required
      Home Phone:

      required

      Cell Phone:  

      required  

      Work Phone:
      required 

      How did you hear about the Children’s Centre?
       required
      Name of Parent:
      Email Address:
      Additional Information: Is there anything that you would like us to know about your child?