WAITLIST FORM

Parent / Guardian # 1 (First name)

Parent / Guardian #1 (Last name)

Company name

Place of Work/School:

Child's Date of Birth:

Year

Month

Day

Please note: South Hill Child Care Society accepts children starting at 30 months (2½ years) of age or older at the time of enrollment.

Child's gender:

Phone

Preferred method of contact:

Will you be applying for the Affordable Child Care Benefit?

Give us more details:

I confirm that the information provided is accurate.

I understand this form places my child on the waitlist and does not guarantee enrollment.

I understand that South Hill Child Care Society only accepts children who are already 30 months (2½ years) of age or older at the time of enrollment.

I agree to wait to be contacted by South Hill Child Care Society.