Note: Your child's birth date is required! Please be sure to include your child's birth date where requested below.

download as a pdf APPLICATION FORM Care Required: -choose- Full-time Part- time M/W/F Part-time T/Th Start Date Requested: Child’s Information: First Name: Last Name: Sex: -choose- Male Female Date of Birth: (mandatory information) Address: City Province: ALBERTA BRITISH COLOMBIA MANITOBA NEW BRUNSWICK NEWFOUNDLAND NORTH WEST TERRITORIES ONTARIO PRINCE EDWARD ISLAND QUEBEC SASKATCHEWAN YUKON Postal Code: Home Phone: Siblings and Ages: Does the child have any special diet, rest or exercise requirements? Parent/Guardian Information:   Mother’s Name: Contact email address: Phone(h): Phone(w): Home Address: Workplace: Work Address: Father’s Name: Phone(h): Phone(w): Home Address: Workplace: Work Address: Signature of Parent/Guardian: Date: