RayCam Co-Operative Licensed Childcare Waitlist Form
Raymur Place Daycare
Name of Child
*
First Name
Last Name
Child's Date of Birth
*
-
Month
-
Day
Year
Date
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.
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 child have any developmental or behavioural needs?
*
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: