Contact the licensed family childcare provider

Licensed Family Childcare
An essential service in the community of White Rock.

Registration Form
If you are interested in
discussing current openings and availability, please fill out the online registration form.

Jennifer
White Rock, BC Canada

Tel: 604-788-6918

Providing the quality care your child deserves.

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Openings & Availability

New Space Available!
Now accepting applications

Please fill out the registration form below.

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Child Registration Form

Please provide your contact information * - indicates mandatory field
* Parent name:
* Phone number:
	Daytime	Evening
Alternate number:
	Daytime	Evening
* E-mail:

Please provide information about your child
Child 1 Name:
Age:
Birthdate:
	Male	Female
Child 2 Name:
Age:
Birthdate:
	Male	Female

Date that childcare is to commence
dd/mm/yy
Days required:	Full-Time	Part-Time

Comments or questions?

This registration will be reviewed once I receive it and I will contact you to discuss current availability.

Thank-you for your interest.


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