Child Care Inquiry Form

IF WE HAVE A WAITLIST WE WILL PLACE YOU ON IT AND CONTACT YOU AS SOON AS A SPOT OPENS FOR YOUR CHILD.
Parent/Guardian Name to Contact

First NameLast Name
E-mail
Contact Number

Attendance: tick the days you would like your child to attend and write the times.

Desired Start Date

MonthDayYear
Date
Primary Language Spoken by child and family
If other than English, what is the child's English Proficiency?
Does your child have a disability or do you have any concerns about your child's development? If yes, please explain
Does your child require any social/emotional support? If yes, please explain
Should be Empty: