Daycare Services Request Form

If your child is registered for elementary school at EMCS and you plan to use daycare services during the school year, please fill out the form below. Thank you.

Family Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

1. Student Name / Grade / Date of birth

Medicare card

2. Student Name / Grade / Date of birth

Medicare card

3. Student Name / Grade / Date of birth

Medicare card

4. Student Name / Grade / Date of birth

Medicare card

When will you be using daycare service

Please choose the day and time you prefer to utilize the daycare service.

Morning (7:15 am to 8:00 am)

Evening (3:05 pm to 6:00 pm)

Monday

Tuesday

Wednesday

Thursday

Friday

PED day

Line

In case of emergency, please contact

First Name

Last Name

Phone

(###)

###

####

Relationship

Line

Message