Salmonberry Child Care Centre Waitlist Application Form

Step 1 of 10

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How many children would you like to add to the waitlist?*

One

Two

Three

Four

Five

1st Child Information

Name*

First Last

Birthdate*

MM slash DD slash YYYY

Gender*

Female

Male

Non-Binary

Other

Please specify:*

Which class waitlist(s) would you like your child added to?*

Has your child been registered at any of our South Vancouver Neighbourhood House Preschool and/or Family Programs since January 2021?*

Yes

Please provide program name:*

Does your child have any extra support needs, or other care needs we should be aware of to provide our best care?*

Yes

If yes, please specify:*

2nd Child Information

Name*

First Last

Birthdate*

MM slash DD slash YYYY

Gender*

Female

Male

Non-Binary

Other

Please specify:*

Which class waitlist(s) would you like your child added to?*

Has your child been registered at any of our South Vancouver Neighbourhood House Preschool and/or Family Programs since January 2021?*

Yes

Please provide program name:*

Does your child have any extra support needs, or other care needs we should be aware of to provide our best care?*

Yes

If yes, please specify:*

3rd Child Information

Name*

First Last

Birthdate*

MM slash DD slash YYYY

Gender*

Female

Male

Non-Binary

Other

Please specify:*

Which class waitlist(s) would you like your child added to?*

Has your child been registered at any of our South Vancouver Neighbourhood House Preschool and/or Family Programs since January 2021?*

Yes

Please provide program name:*

Does your child have any extra support needs, or other care needs we should be aware of to provide our best care?*

Yes

If yes, please specify:*

4th Child Information

Name*

First Last

Birthdate*

MM slash DD slash YYYY

Gender*

Female

Male

Non-Binary

Other

Please specify:*

Which class waitlist(s) would you like your child added to?*

Has your child been registered at any of our South Vancouver Neighbourhood House Preschool and/or Family Programs since January 2021?*

Yes

Please provide program name:*

Does your child have any extra support needs, or other care needs we should be aware of to provide our best care?*

Yes

If yes, please specify:*

5th Child Information

Name*

First Last

Birthdate*

MM slash DD slash YYYY

Gender*

Female

Male

Non-Binary

Other

Please specify:*

Which class waitlist(s) would you like your child added to?*

Has your child been registered at any of our South Vancouver Neighbourhood House Preschool and/or Family Programs since January 2021?*

Yes

Please provide program name:*

Does your child have any extra support needs, or other care needs we should be aware of to provide our best care?*

Yes

If yes, please specify:*

Parent/Guardian Information

Name*

First Last

Relationship to child*

Home Address*

Street Address Address Line 2 City Province Postal Code

Is this the main residential address for each child?*

Yes

If no, please provide the residential address(es) for your child(ren):*

Do you work at ANHBC?*

Yes

If yes, please state where you work:*

Add Work Address?*

Yes

Business Name*

Work Address*

Same as home address

Street Address Address Line 2 City Province Postal Code

Primary Phone*

Type*

Cell

Home

Work

Add another phone number?*

Yes

2nd Phone*

Type*

Cell

Home

Work

Add another phone number?*

Yes

3rd Phone*

Type*

Cell

Home

Work

Email*

Add another parent/guardian?*

Yes

2nd Parent/Guardian Information

Name*

First Last

Relationship to child*

Home Address*

Same as other parent/guardian

Street Address Address Line 2 City Province Postal Code

Is this the main residential address for each child?*

Yes

If no, please provide the residential address(es) for your child(ren):*

Do you work with ANHBC?*

Yes

If yes, please state where you work:*

Add Work Address?*

Yes

Business Name*

Work Address*

Same as home address

Street Address Address Line 2 City Province Postal Code

Primary Phone*

Type*

Cell

Home

Work

Add another phone number?*

Yes

2nd Phone*

Type*

Cell

Home

Work

Add another phone number?*

Yes

3rd Phone*

Type*

Cell

Home

Work

Email*

Additional Information

What is your desired start date?*

MM slash DD slash YYYY

Do you have any other children who attend Salmonberry Child Care Centre?*

Yes

If yes, please specify child(ren)'s name(s):*

Consent

Please review and agree to the following statements:*

I confirm that the information I have provided is true and accurate.

I understand that my child(ren) is(are) not guaranteed a space in the childcare program.

I understand that I must pay a non-refundable fee of $25 per child to have my child(ren) added to the waitlist, and this fee does not represent a guarantee that my child(ren) will be enrolled in the program.

I understand the SVNH will contact me in the event that a space comes available for my child(ren) to enroll in the program.

Please submit the form below to have your child(ren) added to the waitlist for Salmonberry Child Care Centre, which will open on October 01, 2021.

You can add your child to the waitlist for the Toddler class (18 to 36 months), the 3 to 5-year-old class, or both waitlists.

Please click here to review waitlist requirements.

1st Child Information

2nd Child Information

3rd Child Information

4th Child Information

5th Child Information

Parent/Guardian Information

2nd Parent/Guardian Information

Additional Information

Consent

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