Campus Children's Centre Waitlist

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Contact Name - Dawn Montebruno
Primary Phone Number - 204-474-9546

Email *

Time Stamp of Date of Entry Question *

YYYY

Primary Contact Name *

Primary Contact Address *

Primary Contact Phone Number *

Primary Contact Email Address *

Child's Name *

If Child is not born yet, please indicate here and add Expectant Birth Date in next Question *

Already Born

Not Yet Born

Child's Birthdate *

YYYY

Child's Current Age *

Child's Gender *

Female

Male

Prefer not to say

Other:

Requested Start Date *

YYYY

Program/Service Type *

Infant

Preschool

Kindergarten

Type of Care *

Full Time

Part Time

Affiliation List - select all that apply *

Sibling of currently enrolled child

Indigenous

Undergrad Student

Child of UofM Staff

Graduate Student

Other:

Required

Are there any Additional Support Needs *

Yes

Previously on the Online Childcare Registry *

Yes

Any further comments you want us to be aware of, such as additional concerns regarding your child, need for care, not in the province yet, etc

Submit

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