Moozoons Child Care Centre - APPLICATION FORM

Application Form - Moozoons Child Care Centre

For more information, please contact:

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Contact Person

Christine Tougas, Child Care Supervisor

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Phone Number

807-727-3000, ext 235

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Email Address

childcare@rlifc.ca

Child's Name

Date of Birth or Expected Due Date

Parent's Name

Address

Town/City

Postal Code

Cell Phone

Work Phone

Parent's Name

Address

Town/City

Postal Code

Cell Phone

Work Phone

Requested Start Date

Are your needs flexible?

Select Days Needed Select Days Needed Monday Tuesday Wednesday Thursday Friday

Hours

Other Information

Is your child Indigenous or of Indigenous descent? Is your child Indigenous or of Indigenous descent? Yes No

Do you qualify for a child care fee subsidy? Do you qualify for a child care fee subsidy? Yes No

Do you have other children who attend the RLIFC Child Care Centre? Do you have other children who attend the RLIFC Child Care Centre? Yes No

6 + 9 =

By submitting this form, you agree to sign this application form electronically. It will be dated on the date that it is received at our office inbox. We will confirm receipt of your application.

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