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Please note: No refunds for online purchases.

* Indicates required information

First child

Child's name: *

Month Day Year

Day of Birth: *

Gender: *  Female   Male

Does your child have any medical conditions the staff should be aware of (i.e. allergies)?

Indicate any special medical attention your child may require:

Is your child's immunization up to date? *
(for clients subsidized by The Region of Waterloo Child Care Subsidy, please answer yes or no)

Yes   No Declined

For possible future advertising we need consent from parent to include photographs and video of children *

Yes   No


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If you have a promotion code, enter it here:

Emergency contact information

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Relationship: *

Home phone: *

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