Waitlist-Burnaby South Child Care

Title *

Today's Date:

Parent/Caregiver Full Name (First and Last): *

Email Address: *

Phone Number: *

Home Address: *

Child's Year of Birth: *

This centre serves children 8 weeks to 36 months of age only. Most openings are for our infant room (under 12 months).

Child's Month of Birth: *

Name of Child:

If child is not yet born, please leave blank or enter unknown. Once child is born, please contact us to update with name.

Desired Start Date: *

Note that desired start date should be the date your child would first like to attend the program.

If your desired start date has passed, would you like to remain on the list? *

Comments:

ADMIN ONLY (Exit Waitlist?):

ADMIN ONLY (Reason for exit):

ADMIN ONLY (notes):

ADMIN ONLY: Exit Date:

Attachments:

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