Waiting List
*PLEASE NOTE: Waiting List submissions are only active for three (3) months after your desired start date. If you have not secured a spot after three (3) months of your desired start date, you will need to complete a new Waiting List submission. Fields marked with a * are required.
Date
*
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Month
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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 Full Name
Child's Birth Date
*
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Month
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Day
Year
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Desired Start Date for Child Care
*
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Month
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Day
Year
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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
Desired Program
*
Please Select
Milton Infant (3-18 months)
Milton Toddler (18 months to 2.5 years)
Milton Preschool (2.5 to 5 years)
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
Submit
Should be Empty: