City View Centre for Child and Family Services

SCHOOL AGE / KINDERGARTEN REGISTRATION

School Age / Kindergarten Program
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
Name of School:
Grade:
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
Name of School:
Grade:
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
Name of School:
Grade:

Please give us a date or approximate date you wish care to begin:
Please indicate which care days apply              
Do you require part time care only? Note: We only provide Part time care on a full time basis. Please explain needs:
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  

                                                                                                     

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