Ô Koala Waitlist Form
Expected start date
*
-
Month
-
Day
Year
Date
Preferred location
*
Other
Ottawa
Toronto
Hamilton
Georgina
Markham
Preferred location or intersection of home daycare
*
Preferred language of home daycare (English, French etc.)
*
Parent/Guardian Information
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child Information
Child Name
*
First Name
Last Name
Gender
Male
Female
Other
Date of Birth
*
-
Month
-
Day
Year
Date
Grade Level
School
Hours of care from:
*
Hour Minutes
AM
PM
AM/PM Option
Hours of care To:
*
Hour Minutes
AM
PM
AM/PM Option
Parent acknowledgment and approval to enroll in waitlist
Signature of Parent/Guardian
Date Signed
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: