Online Waitlist Application

Online Waitlist Application

Completing this application form places your child on the waitlist for mem7iman Child Development Centre, but does NOT guarantee a spot for your child. (Please note: if there is more than one child, there will need to be seperate applications for each child). Offers for a space become available at any time throughout the year. It is your responsibility to notify us if your contact information changes.
Date of Application *

Day Month Year
Date
Name of Child *

First Name Last Name
Date of Birth (or Delivery Date) *

Day Month Year
Date
shishalh Nation Membership

Yes No Not yet determined Prefer not to disclose
Desired Date of Entry

Day Month Year
Date
Program Required *

Infant / Toddler Group Care (3-5)
Parent / Guardian Name #1 *

First Name Last Name
Working

Full-Time Part-Time Unemployed Prefer not to disclose
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *
E-mail *
example@example.com
Parent / Guardian Name #2

First Name Last Name
Working

Full-Time Part-Time Unemployed Prefer not to disclose
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number
Email
example@example.com
Is there anything that you would like us to know about your child?
Thank you for your interest in mem7iman. You will receive an email confirming when your application has been received.
The personal information on this form is used only for the purposes stated at the beginning of the form. Your information will remain confidential, and will only be used to determine a spot at our child care Centre. Should you have any questions about the collection and use of this information, please contact mem7iman@shishalh.com.
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