Wait-list Form
Preferred Program
*
Preschool (West Kelowna)
Casa 3-5 Full Day (West Kelowna)
Petite 0-3 Full Day(West Kelowna)
Name of Child
*
First Name
Last Name
Birthday
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preferred Start Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age at start date:
*
I require care from (open hours 7:45am-4:45pm)
Time
AM
(pm)
*
Number of days per week (required):
*
Name of parent
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email:
*
example@example.com
Notes:
Enter the message as it's shown
*
Submit
Should be Empty: