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Child Intake Form
Name
*
First
Last
Email
*
Enter Email
Confirm Email
Phone
*
Are you looking for full or part time care?
*
Select All
Monday
Tuesday
Wednesday
Thursday
Friday
Do you qualify for child care subsidy?
*
Yes
No
Don't Know
When is your ideal start date?
Date Format: MM slash DD slash YYYY
Which location do you prefer?
Uptown Salmon Arm
Canoe
Would you be willing to attend the alternate location until your preferred location becomes available?
Yes
No
Child's Name(s)
*
First Name(s)
Last Name
Child's Date of Birth
Date Format: MM slash DD slash YYYY
Notes:
Please describe any behavioural or learning needs, previous daycare experience and expectations for care.
Add another child
Add a second child
Second Child's Name(s)
*
First Name(s)
Last Name
Second Child's Date of Birth
Date Format: MM slash DD slash YYYY
Notes:
Please describe any behavioural or learning needs, previous daycare experience and expectations for care.
When would be the best day for a tour of the daycare
Tue
Wed
Thu
Fri
Please check all availability
When would be the best time for a tour of the daycare
9 am
9:30 am
3 pm
3:30 pm
Please check all availability
Do you have any questions?
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