Childcare Centre Application Form

This application form means that your child will be put on our waiting list. Please note that the name and contact information for at least one parent must be completed. Those declared by Revenue Canada as having an income of $40,000 or more do not qualify for our childcare program.


Required fields are marked with an asterisk (*)



Child's Name *
Mother's Name:
Father's Name:
Home Number * ( ) -
Work Number (Mother) ( ) -
Work Number (Father) ( ) -
Child's Date of Birth *
Child's Gender * Male
Female
Gross Family Income for Year *