Day Care Enrolment Request Mar 11, 2021 Day Care Enrolment Request New applicant/Returning applicant? New applicant Returning applicant Date Date Format: MM slash DD slash YYYY Name of the Child First Last Name called at home First Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country GenderAgeDate of Birth Date Format: MM slash DD slash YYYY Place of BirthChild's Home PhoneChild's First LanguageName of the Parent First Last Email Parent #1 Cell #Parent #1 Work #Name of Parent #2 First Last Email Parent #2 Cell #Parent #2 Work #Please check the boxes that meets your need3-5 years old - 2 days a week; Fees - $430; 8 a.m. - 5:30 p.m.; Days Needed Monday Tuesday Wednesday Thursday Friday 3-5 years old - 3 days a week; Fees - $630; 8 a.m. - 5:30 p.m.; Days Needed Monday Tuesday Wednesday Thursday Friday 3-5 years old - 5 days (fulltime); Fees - $915; 8 a.m. - 5:30 p.m. Monday - Friday 30-36 months old - 2 days; Fees - $500; 8 a.m. - 5:30 p.m.; Days Needed Monday Tuesday Wednesday Thursday Friday 30-36 months old - 3 days; Fees - $700; 8 a.m. - 5:30 p.m.; Days Needed Monday Tuesday Wednesday Thursday Friday 30-36 months old - 5 days (fulltime); Fees - $900; 8 a.m. - 5:30 p.m. Monday - Friday At MPNH childcare programs, we are committed to offering quality affordable programs and services to all our children and families, regardless of their cultural and socio-economic status. Will you be accessing the affordable childcare benefit?* Yes No Your application is only considered complete once we have received your $5.00 deposit through the 'Donate' Page. Please call us to do the payment or pay at the front desk.* Yes No Some important points to note*After confirmation of space, you will be contacted to pay on one time, $50 registration fee and a registration package will follow *Completion of the registration package is mandatory before your child may start the program *12 Post-dated cheques or monthly Electronic Fund Transfer (EFT) are the only options for payment *First and Last month fees are cashed at the time of registration *Fees include the provincial fee reductionUntitled First Choice Second Choice Third Choice We are not accepting online payments for childcare applications. Please call at 604.879.8208 to pay the fee or pay at our front desk. Sorry for the inconvenience. We are working on this. Thank you.
