Little Lights Early Learning Centre Waitlist

Please note: Priority is given to those requiring full-time care.

Child #1 Information

First Name*

Middle Name

Last Name*

Birthdate*

Age*

Gender

Child #2 Information

First Name

Middle Name

Last Name

Birthdate

Age

Gender

Please Answer The Following

Please note: Priority is given to those requiring full-time care.

Please Select Start Date*

Do You Require Full Day or Part Day Care?*

Please Select Which Days You Will Require Childcare

Monday

Tuesday

Wednesday

Thursday

Friday

Mother's Information

Mother's First Name*

Mother's Last Name*

Mother's Phone Number*

Mother's Email Address*

Father's Information

Father's First Name*

Father's Last Name*

Fathers's Phone Number*

Father's Email Address*

Home Address

Street Address*

City*

Postal Code*

Mailing Address
(if different from above)

City

Postal Code

Comments

Please add any other information you would like us to know