Wait List Request Form - Early Learning Centres

Please fill in this form to have someone contact you regarding your child care needs. Depending upon enrollment, you may be eligible for a space or may be put on a wait list for services. Thank you for your interest in our quality Early Learning Centres.

Parent's Names:

Address:

Child's Name:

Child's Date of Birth:

Telephone:

Mobile Number:

Email Address:

Work Place and Telephone Number:

What type of care are you looking for?:

Infant/Toddler (birth to 36 months)

Child Care (3 - 5 years)

School Age (6-12 years)

Days Needed:

Monday

Tuesday

Wednesday

Thursday

Friday

Times Needed Each Day:

Please indicate the times your child needs care Monday - Friday

How did you hear about us: - None -InternetFriendNewspaperPosterYellow PagesMagazineNewsletterOther

Any additional Information:

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