Registration Form - Le Petit Childcare

Application Date

Please complete all sections of the waitlist application. Submitting this application does not guarantee a space for your child. Spaces are offered as they become available based on established criteria. Please submit a separate application for each child. Future siblings require a separate application. Should your contact information change, please ensure you e-mail us.

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Application for space in

Toddler (18 to 36 months)Group 3 to 5 yearsFull-timePart-time

Child’s Information

First Name

Family Name

Preferred Name

Date of Birth

Home Addressyour home / office

Registration Fee:

We will contact you when a space is available and will give you the option of taking the space or remaining on our waiting list. Once you have confirmed a space, please note a $150 non-refundable registration fee is required to save the space for your child and ensure it is not given away. This fee does not guarantee a placement. However, we will make every effort to ensure that a spot will be available for your child on his/her anticipated start date.

Requested Approximate Starting Date

Starting Dateof appointment

Days and times requested.

Dateof appointment

of appointment

Parent/Guardian One

Name:

Home Telephone:

Employer:

Home Address:

Work Telephone:

Cell Phone:

Email:

Work Address:Work Address:

Any other details which may assist us to accommodate your requirements.