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Application for Daycare Enrollment
Filling out this application form and applying for daycare is important because it dates your childcare application and allows us to offer daycare spaces to children in a first come first serve order.
Step 1 of 2 - Personal Information
50%
Parent Information
Name
*
First
Last
Address
Street Address
City
Zip / Postal Code
Phone
Email
Child Information
Child Name
First
Last
Gender
Male
Female
Birth date
*
mm/dd/yyyy
Carecard Number
Program
select
Ages 3 months to 3 years
Ages 2 1/2 years to 6 years
Preferred Location - First Choice
select
Central Nanaimo - Nadely Crescent Location (ages 2 1/2 to 6)
Downtown Nanaimo - Selby Street Location (ages 0 to 6)
South Nanaimo - Irwin Street Location (ages 0 to 6)
South Nanaimo - Strickland Street Location (ages 0 to 3)
Greater Victoria (Langford) - Bray Avenue Location (ages 0 to 6)
Second Choice if preferred location is not available
select
Central Nanaimo - Nadely Crescent Location (ages 2 1/2 to 6)
Downtown Nanaimo - Selby Street Location (ages 0 to 6)
South Nanaimo - Irwin Street Location (ages 0 to 6)
South Nanaimo - Strickland Street Location (ages 0 to 3)
Greater Victoria (Langford) - Bray Avenue Location (ages 0 to 6)
Full Time (5 days per week)
Part Time
If part time, please indicate which days you request:
Mondays
Tuesday
Wednesday
Thursday
Friday
Requested Start Date:
*
mm/dd/yyyy
Please tell us how you heard about Jolly Giant Childcare:
Other information, questions, and/or comments:
Comments
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