EmailMe Form - Kelly's Family Child Care Enquiry Form

Parent Name *

First Last

Email *

Phone Number *

### - ### - ####

Preferred Contact Method *

Email

Phone (Anytime during the day)

Phone (Specific Time)

Home Address

Street Address City State / Province / Region Postal / Zip Code Country / Region

* Child Information *

Child Name *

First Last

Gender *

Boy

Girl

Date of Birth *

MM / DD / YYYY

Main Language

English

Cantonese

Mandarine

Others

* Child Care Service Requesting *

Start Date *

MM / DD / YYYY

End Date

MM / DD / YYYY

Child Care Type *

Full Time

Part Time

Before / After School Care

For specific Day/Hour , please enter information below.

Days

Start Time

HH : MM AM/PM

End Time

HH : MM AM/PM

For special request, please explain:

* Questions or Comments *

Pleaes let us know if you have any questions.

How did you hear about "Kelly's Family Child Care" ?
Whom may we thank for referring you?

Kelly's Family Child Care

1618 E.34th Ave Vancouver BC V5P 1A1
phone: (604)321-8418
e-mail: KFCC34@gmail.com

***** Child Information *****

***** Child Care Service Requesting *****

***** Questions or Comments *****

Kelly's Family Child Care

* Child Information *

* Child Care Service Requesting *

* Questions or Comments *