Online Waitlist Application

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Application Date Date of Child Care required Child's Name Date of Birth (or due date) Gender MaleFemale Part Time/Full Time Request 5 Days-Full Time3 Days-M/W/F3 Days-T/Th/F2 Days-M/W2 Days-T/ThOther Name of Parent Applying Priority Status StudentCapilano EmployeeCommunity Address Postal Code Email Address  Enter a valid email address. Example: name@company.com Home Phone  Enter a valid phone number. Example: 123-456-7890 Work Phone  Enter a valid phone number. Example: 123-456-7890 Parent Priority Status StudentCapilano EmployeeCommunity Address Postal Code Email Address  Enter a valid email address. Example: name@company.com Home Phone  Enter a valid phone number. Example: 123-456-7890 Work Phone  Enter a valid phone number. Example: 123-456-7890 Additional Information: Is there anything that you would like us to know about your child?