Centrepointe Childcare Services

TO BETTER SERVE YOU AND YOUR CHILD'S NEEDS, PLEASE FILL IN THE FOLLOWING INFORMATION: A Director will contact you when a space becomes available which meets your family's needs.

Group Care Home Care Nursery School
Age group: 18 months - 5 yrs.
Full Fee Subsidy
Group Care:
Full time enrollment required
Age group: 3 months - 10 yrs.
Full Fee Subsidy
Home Care:
Full time Part time
Age group: 3 & 4 yrs.
Nursery School:
Two afternoon sessions/wk
Date you require care:
Does your child have any special needs we should be aware? (Medical, emotional, intellectual, or physical): If yes:
Parent's Name:
Address:
City: Postal Code:
Telephone: Home: E-mail:
Work: ext:
Child Information:
Child's Name Date of Birth (MM/DD/YY) Current Childcare Arrangement
Specific Questions for Home Care Applicants:
Home Care Area Preferred:
Days of care required:
Hours of care required: From am to pm
Do you prefer your child to be with other children? yes no
If yes, what ages:
Is it important to you that the provider have a structured day?
 Very Less Not at all
School child is attending:
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