Waiting List Form – Leaps & Bounds Children’s Centre

Child's Name*

Date of birth*

Parent / Guardian's Name*

Address*

Street Address City Province

Home Phone*

Cell Phone

Work/School Phone

Email*

Present Child Care

School Child Attending

Which center are you applying to?*

Enrollment Date*

(When you would like to start)

Attendance*

Days*

Monday

Tuesday

Wednesday

Thursday

Friday

Hours (Start of the day)

:

Hours (End of the day)

:

Will you be applying for subsidy?*

Yes

No

Does your child have any identified or unidentified needs?*

Does your child have any allergies or medical conditions?*

Additional information we should know

Do you have other children in care at Leaps & Bounds?*

Yes

No

Which site?*