FEES ARE PAYABLE AT TIME OF CONTRACTING CHILD CARE
Fees CANNOT be refunded or credited in the event of child's illness or other unscheduled absence
BILLING NAME:

Please select your contracted rate category

FAMILY DAY HOME:
CAMROSE CHILDREN'S CENTRE:

IMMUNIZATIONS ARE UP TO DATE?
INTIALS:

SIGNATURE (TYPE YOUR NAME):
DATE:

IF YOUR CONTACT INFORMATION HAS CHANGED, PLEASE COMPLETE:

HOME ADDRESS:
CITY:

PROVINCE:
POSTAL CODE:

CELL:
HOME:
WORK:

EMPLOYER: