Western Day Care Centre
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Please fill out the following form to place your child on our waiting list.
Child's Name:
*
Date of Birth:
*
Mother's Name:
Father's Name:
Home Phone:
Home Address:
*
Postal Code:
*
Other Contact Numbers:
Cell / Work
Email Adress:
*
Select Location:
*
select...
Blue Heron
Emery Street
Date Wanted:
Full time / Part time
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Math question:
*
1 + 1 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
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