Parents Name: Childs Name: Childs Date of Birth * : Day Time Telephone Number: Home Telephone Number: E-mail Address * : Date Care is Required * : Program * : Infant (6 weeks - 18 months) Toddler (18 months - 30 months) Preschool (2 1/2 - 4 years) JK (4-5 years) SK (5-6 years) Full Time   Part Time any two days any three days any four days   Monday Tuesday Wednesday Thursday Friday Preferred Location(s) * : (Please choose all that apply)   Acton Mill Street Acton Barrie Mapleview Brampton Avondale Mill Street Brampton Queen St. Sandalwood Burlington South Service Rd Cambridge Maple Grove Sheldon Drive Georgetown Main St Georgetown Hamilton Waterdown Hamilton St Waterdown Leap Kitchener Victoria St. Milton Derry Escarpment South Maple Ave. Mississauga Dixie Matheson Torquay Mews Traders Wolfedale Newmarket Yonge St. Oakville Winston Churchill Orangeville Third St. Vaughan Trowers Rd.  Are you receiving or have you applied for subsidy? * : YesNo  How did you hear about Peekaboo? I accept the terms of the Privacy Policy *   * Indicates a required field