WAIT LIST

You are applying for our Halifax, Nova Scotia wait list.

You are placing your name on a waiting list only. This does not guarantee a place in our centre.

All information submitted will remain confidential and will only be used to contact you about possible placement or your desire to remain on our wait list. Please ensure the accuracy of all submitted information and notify us if contact information changes.
An intake meeting may be required to determine the suitability of a child in a particular classroom. To ensure the safety and quality care for all children, we may not be able to accommodate every child we contact.
Once accepted and prior to placement, each child must have a completed Parent Package on site 3-4 days prior to the start date.
Every effort will be made to allow families to visit the centre before making any commitments.

Please note: the form may return an error message if you use auto-fill.

Child's name *

First

Last

(baby or infant okay if unknown)

Date of Birth *

Gender

Preferred Start Date *

Care Required *

Does your child have special needs? *

Special needs include diagnosed or undiagnosed Autism, physical or other delays and behavioural issues.

Parent or Guardian #1 *

First

Last

Parent or Guardian #2

First

Last

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Phone number *

must include area code

Email *

Description of child's special needs or other comments