Waiting List
Fields marked with a * are required.
Date
*
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Month
-
Day
Year
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Name
*
First Name
Last Name
Home Phone
*
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Area Code
Phone Number
Cell Phone
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Area Code
Phone Number
E-mail
*
Child's First and Last Name
First Name
Last Name
Child's Birth Date
*
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Month
-
Day
Year
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Desired Start Date for Child Care
*
-
Month
-
Day
Year
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What school does your (or will your) child attend?
School Name
What Grade Will Your Child Be In When Care Is Needed? If Your Child Is Not Enrolled, Please Select N/A
Please Select
N/A
JK/SK
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Does your child require any of the following services? (Please select all that apply)
*
Behavioural therapy
ErinoakKids
Integration/Inclusion services
Occupational therapy
Physio therapy
Region of Halton Child Care Fee Subsidy
ROCK
Speech and language therapy
Not Applicable
Other
Program
*
Please Select
Oakville Toddler (2 to 2.5 years)
Oakville Juniors (2.5 to 4 years)
Oakville Before School Program (JK/SK)
Oakville After School Program (JK/SK)
Oakville Both Before/After School Program (JK/SK)
Oakville Before School Program (6 to 10 years)
Oakville After School Program (6 to 10 years)
Oakville Both Before/After Program (6 to 10 years)
Has your child had any child care or group experience?
*
Yes
No
Additional Comments
Where Did You Hear About Us?
Please Select
Referral From Existing/Former Parent
Referral From Staff Member
Referral From Community Member
Facebook
Internet Search
Other
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