Part-Time Nursery School Application
Jackman Community Daycare operates a Part-Time Nursery School Program for 3 year olds.
The program operates during the school year from 9:00-11:30 AM. Two, three or five-day options are available.
(Families who require full-time care need to apply for daycare using the DAYCARE APPLICATION FORM.)
* Required
Child's Last Name
*
Last Name
Your answer
Child's Given Name(s)
*
Your answer
Child's Year of Birth
*
Choose
2021
2020
2019
2018
Child's Month of Birth
*
Choose
January
February
March
April
May
June
July
August
September
October
November
December
Child's Day of Birth
*
Choose
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Sex
Choose
Male
Female
Other
Prefer not to answer
Home Address (including Postal code)
*
Your answer
Parent # 1: Name
*
Your answer
Parent #1: Email Address
*
Your answer
Parent # 1: Primary Phone Number(s)
*
Your answer
Parent # 2: Name
Your answer
Parent # 2: Email Address
Your answer
Parent # 2: Primary Phone Number(s)
Your answer
Please check your preference (your choice will not impact your acceptance - you can change your mind):
Choose
5-days/week (Monday-Friday)
3 days/week (Monday/Wednesday/Friday)
2 days/week (Tuesday/Thursday)
Siblings (if any) & their birth year
Your answer
Other information relevant to the application
Your answer
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
