City View Centre for Child and Family Services

Day Care Registration

Day Care Centre
Fees

 

     Please complete the following information and submit by clicking the “submit” button provided.  Your completed application will then go into our data base waiting list.  Should a space become available we will contact you.  If you require assistance completing this form please do not hesitate to contact us.  Registration can be made by phone, fax or submitting this online form.  Thank you for considering our program for your children’s day care needs.

 

PARENT'S FIRST NAME:
LAST NAME:
ADDRESS:
POSTAL CODE:
HOME PHONE:
WORK PHONE:
CELL OR OTHER:
EMAIL ADDRESS:

1st Child's Name:  
First Name:
Last Name:
Birth Date: (dd/mm/yy): 
Does you child have allergies,
medical conditions, or any special needs:		 YES      NO   
If Yes Please Describe
Is this child presently on any medications? YES    NO 
If Yes, please describe and give details
TOILET TRAINED? YES         NO       
2nd Child's Name:  
First Name:
Last Name:
Birth Date: (dd/mm/yy): 
Does you child have allergies,
medical conditions, or any special needs:		 YES      NO   
If Yes Please Describe
Is this child presently on any medications? YES    NO 
If Yes, please describe and give details
TOILET TRAINED? YES         NO   
3rd Child's Name:  
First Name:
Last Name:
Birth Date: (dd/mm/yy): 
Does you child have allergies,
medical conditions, or any special needs:		 YES      NO   
If Yes Please Describe
Is this child presently on any medications? YES    NO   
If yes, please describe and give details
TOILET TRAINED? YES         NO   

Please give us a date or approximate date you wish care to begin:
Please list any concerns you may have which will assist us in providing the best possible care for your children
Do you require a subsidy space with our program? Yes     No  
If you have indicated "No" please refer to our Fee Pay Policy  

                                                                                                     

       Back to Day Care                                           TOP OF PAGE

    Date Completed:       

Copyright © 2002 [City View Family Day Care]. All rights reserved.
Revised: February 26, 2003