Parent/Guardian's Name *

First Name

Last Name

Parent/Guardian's Phone *

(###)

###

####

Child's Name *

First Name

Last Name

Child's Birthdate *

MM

DD

YYYY

How many children are you inquiring for? *

1

2

3

Do any of the following apply to your family?

Child with allergies

Child with medical needs (Ie. Asthma, febrile seizures)

Child with special needs

Working with a Resource Consultant

Children requiring subsidy through Simcoe County

Vulnerable children

Francophone

Indigenous

Caribbean or African descent

Newcomer Families

Families living with low income

Young parents

Other