EARLY LEARNING ENROLLMENT INQUIRY

Today's Date * +

Parent/guardian first name *

Parent/guardian last name *

Parent/guardian first name

Parent/guardian last name

Primary phone number *

Alternate phone number

Email address *

Mailing address (optional)

#1 child name *

#1 child's birthdate * +

#1 child early learning program inquiring about *

#2 child name

#2 child's birthdate +

#2 child early learning program inquiring about

Is your child currently enrolled at a preschool or daycare? *

If yes, current name of preschool or daycare.

Please explain if there is anything you would want us to know about your child (health concerns, speech, hearing or visions problems, etc). *

Which campus are you interested in? Check all that apply. *

Fleetwood Campus, Extended JK (8888 162 Street)

Cloverdale Campus, Extended JK & Daycare (5950 179 Street)

Clayton Campus; Daycare (18625 Fraser Hwy)

How did you hear about us? *

I am available for a campus tour on (check all that apply) *

For office use only (notes)