Wait List Application – Panda Childcare

Wait List Application

Panda Location*
Requested Start Date*
MM slash DD slash YYYY
Child's Date of Birth*
MM slash DD slash YYYY
Child's Name*
First Last
Parent / Guardian Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone (h)
Phone (w)
Phone (c)
Email Address*
You will be charged a $30.00 non-refundable administration fee to place your child on the wait-list. Please contact your centre monthly via e-mail or by phone to confirm your child's spot on the wait-list.
Parent / Guardian Signature