Day Care Enrolment Request

New applicant/Returning applicant?

New applicant
Returning applicant

Date

Name of the Child

First Last

Name called at home

First

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Gender

Age

Date of Birth

Place of Birth

Child's Home Phone

Child's First Language

Name 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 need

3-5 years old - 2 days a week; Fees - $425; 8 a.m. - 5:30 p.m.; Days Needed

Monday
Tuesday
Wednesday
Thursday
Friday

3-5 years old - 3 days a week; Fees - $620; 8 a.m. - 5:30 p.m.; Days Needed

Monday
Tuesday
Wednesday
Thursday
Friday

3-5 years old - 5 days (fulltime); Fees - $890; 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 - $750; 8 a.m. - 5:30 p.m.; Days Needed

Monday
Tuesday
Wednesday
Thursday
Friday

30-36 months old - 5 days (fulltime); Fees - $1250; 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

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 reduction

Please check the boxes that meets your need

Some important points to note

Categories