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*First Name: *Child’s Name:
*Last Name: *Child's Birthday:
*Home Phone: *Desired Start Date:
Cell Phone:
*Email: *Enrollment: Full-Time    Part-Time
*Part-Time Preferences: Mon   Tue   Wed   Thu   Fri
*Are you receiving or have you applied for subsidy? Yes  No

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*Please note that availabilities are updated once a week. Please call and confirm the availability with the centre.