Child's First Name:	Child’s Last Name:

Date of Birth (day/month/year)

Address:	Home #:

Options for children not as yet in school; infants are only full-week, full-time:

☐ Full-day, full-week care: 7:30 am. to 6:00 pm., Monday to Friday

☐ Full-day, part-week care: Infants are full-time only, 5 days a week

please indicate your choices by numbering in the squares below, 1 to 4, in order of preference:

M + T	M + T + W	W + Th + F	Th + F

Kindergarten and school-age care options are all full-week:

Kindergarten ☐ Frankland or ☐ Jackman or ☐ Withrow

☐ Three-session care: morning, lunch and 3:30 pick-up	☐ Two-session care: morning and 3:30 pick-up

(only option for Frankland and Jackman)	(only option for Withrow students)

Grade 1 and up ☐ Frankland or ☐ Jackman or ☐ Withrow

☐ Three-session care: morning, lunch and 3:30 pick-up	☐ Two-session care: lunch and 3:30 pick-up

(not available for Withrow students)	(not available for Withrow students)

☐ Two-session care: morning and 3:30 pick-up

(only option for Withrow students)

Will you be applying for a fee subsidy through the City of Toronto? ☐Yes ☐ No

Describe your child's health conditions, allergies and diet restrictions:

Parent One	Parent Two

Name:	Name:

Phone #’s:	Phone #’s:

E-mail:	E-mail:

Children’s Circle Daycare will withdraw the current months fees on the 1st business day of the month from the bank account indicated on the Pre-Authorized Debit Agreement. Parents with children on subsidy are required to pay their daily rate at all times while their child is enrolled at Children's Circle Daycare. We require four weeks of paid notice if you are withdrawing your child from care.

For Office Use Only Date of Child's Birth:	(day month year)

Date Applied:	Date Filed:	Date Care Required:

Health Plan required: □ yes □ no	Visiting Days:	Start Date:	Fee: