Application

Application Date: *

Preferred Start Date: *

Program of Interest Age Range:

Toddler/Pre-Casa - 18 months to 3 years

Casa - 3 years to 6 years (must be toilet trained)

First Name: *

Last Name: *

Middle Name:

Date of Birth:

Address: *

Province: *

City: *

Postal Code: *

Country: *

Siblings' names and ages:

Previous school or childcare experience:

Are there any health considerations that would prohibit full participation in school activities?

Yes (please specify)Yes (please specify)

No

Are you aware of any special needs/learning differences that would require special programming for your child?

Yes (please specify)Yes (please specify)

No

Is your child vocal?

Yes

No

What language(s) are spoken at home?

English

French

Other (specify)Other (specify)

Child Lives With:

Parent/Guardian #1

Parents/Guardians

Application Form