Child's Paradise Day Care Centre

Child Registration Waiting List Form

Child Information
Child's First Name:
Child's Last Name:
Date of Birth: Month: Day: Year:
Select Program

Parent Information
Parent Salutation: Mr. Mrs. Miss Ms.
Parent's First Name:
Parent's Last Name:
Address:
City/Town:
Province/State:
Postal/Zip Code:
Country:
Phone Number (please include area code): / /
E-mail Address:
How Did You Find Out Child's Paradise/Reffered By?
Start Date of Care (When Needed): Month: Day: Year:
Days Requested:
Times Requested:
Other important Information:
Image Verification Code:
Please Enter the Verification Code that you see in box to submit.

Thank you for considering Child's Paradise Day Care Centre.
We will contact you shortly.