ORILLIA CENTRAL PRESCHOOL WAITLIST
CHILD'S NAME
BIRTH DATE
/
Month
/
Day
Year
Date
ADDRESS
MOTHER/GUARDIAN
HOME/CELLPHONE
Format: (000) 000-0000.
EMAIL ADDRESS
example@example.com
FATHER/GUARDIAN
HOME/CELL PHONE
Format: (000) 000-0000.
EMAIL ADDRESS
example@example.com
ANY KNOWN ALLERGIES:
ARE THERE ANY SPECIAL HEALTH NEEDS THE STAFF SHOULD BE AWARE OF WITH YOUR CHILD?
Do you require Full time or Part time care?
What is your desired start date?
-
Month
-
Day
Year
Date
Date
/
Month
/
Day
Year
Date
Parent's Signature
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Should be Empty: