Which program are you interested in? (check all that apply)

• Time for Twos
• West Richmond Preschool
• Junior Out-of-School Care
• Senior Out-of-School Care

Parent's First and Last Name:

Email Address:

Contact Phone Number:

Alternate Contact Phone Number:

Message

Child's Name:

Child's Date of Birth:

Second Child's Name:

Second Child's Date of Birth:

What days of the week and times are you interested in?

When do you wish to start?

Disclaimer:
Child care and Preschool wait lists can be quite long. Please note that by filling out this form, it does not guarantee you a space in the program. One of the program coordinators will contact you to let you know if there is space for your request or if you have been placed on the waitlist.

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