Ô Koala Waitlist & Inquiry 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.)
*
Preferred type of service
*
Other
Full Time Monday to Friday
Before School
After School
Before & After School
Are you approved for child care subsidy?
*
If yes, please mention the name of your case worker
Yes
No
My application is submitted but still pending
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 (1)
*
First Name
Last Name
Gender
Male
Female
Other
Date of Birth (Child 1)
*
-
Month
-
Day
Year
Date
Grade Level if applicable
School
Hours of care from:
*
Hour Minutes
AM
PM
AM/PM Option
Hours of care To:
*
Hour Minutes
AM
PM
AM/PM Option
Child Name 2
First Name
Last Name
Date of Birth (child 2)
-
Month
-
Day
Year
Date
Child Name 3
First Name
Last Name
Date of Birth (child 3)
-
Month
-
Day
Year
Date
Parent acknowledgment and approval to enroll in waitlist
Date entered in waitlist
-
Month
-
Day
Year
Date
Submit
Should be Empty: