RayCam Co-Operative Licensed Childcare Waitlist Form
RayCam Centre Out of School Care
Name of Child
*
First Name
Last Name
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Grade
*
Which school does the child attend?
*
Strathcona
Seymour
Name of Parent/Guardian
*
First Name
Last Name
Primary Address of Child
*
Street Address
Street Address Line 2
City
Province
Postal Code
Email for Primary Parent/Guardian
*
example@example.com
Phone Number of Parent/Guardian
*
Please enter a valid phone number.
Format: (000) 000-0000.
Is the family connected with any programs in the neighbourhood? Check all that apply
RICHER
Sheway
Crabtree
Strongstart
Child/sibling previously or currently enrolled in RayCam licensed childcare
Child/sibling previously or currently enrolled in Rec or Family programs at RayCam
Other
Does your family identify with any of the following
Indigenous
Single parent household
New to Canada
Does your child have any developmental or behavioural needs?
*
What is the reason for care? (i.e., parent/guardian is working, is in school, has medical condition, or there is a social worker referral)
*
Is there anything else you would like for us to now about your child or family?
Name of person/organization filling out form if different from parent/guardian name
Submit
Should be Empty: