PELC Application for Childcare Service 2023

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Child's Information

Name of Child
*

Date of Birth
*

YYYY

Gender Assigned at Birth

Male

Female

Clear selection

Please tell us if your child requires extra support

Date Child Care is Required to Begin

YYYY

Main Applicant Information

Main Applicant Name
*

Relation to the child
*

Address
*

Home Phone
*

Cell Phone

Work Phone

Email Address
*

Sibling Information

Tell us if a sibling or siblings is already attending a PELC location and if yes which one

Location Preference

Check all locations that apply
*

Fairhaven – 495 Forrester Rd (Toddler, Preschool, School Age)

Holliston – 1511 Louise Ave (Kindergarten, School Age)

Preston – 1529 Preston Ave (Toddler, Preschool)

Stonebridge – 886 Gordon Road (Infant, Toddler, Preschool)

Willowgrove – 805 Stensrud Rd (Infant, Toddler, Preschool)

Required

Declaration

I/we declare the information given in this application is correct and I/we understand that the personal information contained on this form is used for the purposes of determining eligibility and suitability for child care services, including communication about child care services at the Preston Early Learning Centre Inc. By signing this form, I/we consent to the above described treatment of personal information.

Main Applicant Name for Declaration
*

Date of Main Applicant Declaration
*

YYYY

Completion of this application does not imply that a childcare space will be available when needed. Your application will be put on the centres’ waiting list and you will be notified if a suitable space becomes available.

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