Breadcrumb Trail: Parents > Application Form

Application for Child Care

We have provided this on-line application form for your convenience. If you would prefer to fill out a form by hand and mail it to us, you can print this PDF application form.

If you are unable to view this PDF document, it is likely that you don't have Adobe Reader. You can download Adobe Reader for free by following this link:

At Kawartha Child Care Services, we value your privacy. Form more information, read our Privacy Statement.

Please complete one application per child. There is a non-refundable $40.00 per–family administration fee payable prior to your child's entry into the program.

Application Form

Please enter your information and click submit.
Fields marked with * are required

Child's information:

*Child's Name:
*Date of Birth:

*Gender:

*Address:
*City:
*Postal Code:
*Home Phone #:
School Name:
Grade:

Parent/guardian information:

*Name:
*Address:
*E-mail:
Employer:
Business Address:
Business Phone:
Cell Phone:

During what days and hours of the week is care required?
(Please check all days that apply and provide approximate arrival and departure times.)

Day	Yes	Arrival	Departure
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

How did you find out about our service?

Do you have any questions or comments?

Click the button below to submit your application. We will respond to your application via e-mail within 2 business days.

Peterborough & Area
Home Child Care Program
Peterborough Program
School Age Program
Shamrock Program
City of Kawartha Lakes
Discovery Space
Home Child Care Program
Lindsay Program
Rolling Hills Program
Durham
Bowmanville Program
Courtice Program