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Childcare Interest List

Thank you for your interest in Alexandra Children's Centre. You will be contacted as space becomes available.

Primary Contact Name *

I am interested in

Infant Toddler Care

3-5 Group Care

School Age Care

Child One - Name *

Child One Birth Date (day/month/year) *

Child Two - Name

Child Two Birthdate (day/month/year)

Location *

Requested Start Date (mm/yy)

Your E-Mail *

Your Primary Phone Number *

Your Secondary Phone Number *

Are you new to Alexandra Neighborhood House?

If you answered no, please tell us when you were previously involved.

From:

Month

Day

Year

To:

Month

Day

Year

Would you like to add anything?

Leave this field blank