Parent/ Guardian Name *

First Name

Last Name

Phone *

(###)

###

####

What Program Are You Interested In? *

Infant - (3 months - 18 months)

Toddler - (18 months - 2.5 years)

Casa - (2.5 years - 6 years)

Child Name or Initials *

First Name

Last Name

When would you like your child to start? *

MM

DD

YYYY

Are you looking for Full-Time or Part-Time care? *

Full-Time

Part-Time

Would you still be interested in enrolling if we are not part of the CWELCC program at the time of your child’s start date? *

We are in the process of applying to the Canada-Wide Early Learning and Child Care (CWELCC) program, but participation is not yet guaranteed. Your response helps us better understand your needs as we plan for enrollment. If you're uncertain, feel free to select the option that best reflects your current thinking - we understand things can change.

Yes

No