Child Care Registration Form

PLEASE READ THE FOLLOWING: This form does NOT guarantee your child a place in the Butterfly Learning Centre. Application to the centre using this form puts your child on our waiting list, on a first-come, first-serve basis. Using this secure on-line form is the quickest way to get your child on our list and date stamp your registration to us. If your browser has problems submitting this form, please mail or fax this form to us by printing this page out with the appropriate fields filled out. Each child from your family must be registered on a separate form.

A $30.00 per child, or $50.00 per family, non-refundable registration fee must be mailed to us to complete your registration. Please reference your child's name on the cheque. If your child is accepted, a security deposit of $250.00 is required before your child’s entry date. This deposit will be applied towards the last month’s fees. Daily fees for your child are listed on our fees web page (click here to view).

Please make all cheques payable to 'Butterfly Learning Centre'. A representative from BLC will contact you to confirm electronic receipt of your registration within 2 business days. Please call us if you do not hear from us! We want to make sure your registration is received in good order. Our current mailing address is: Butterfly Learning Centre, 30 Bathurst Drive, Waterloo, ON N2V 1V6 - Telephone 519.880.9021

Please fill out the following information to register:
Your E-mail Address (important): *(required)
Your Real Name (important): *
Child Information
First Name * Middle Name Last Name *
Address
City Province Postal Code
Home Phone Birthday Current Age
Care Information
Are you planning on receiving a fee subsidy? Yes No
* Days of week care required:
Monday Tuesday Wednesday Thursday Friday
Please note that full-time care applicants have preference over part-time
* Specify program in which you wish your child enrolled:
Infant (3-18 mo)
Toddler (18 mo.-2.5 yr)
Preschool (Full Days - 2.5 - 4.5 yrs)
Preschool / Kindergarten (1/2 day - Jr. 3.5-5 yr, Sr. 5 yrs)
After School (5 to 12 yrs)
Summer Camper & P.D. Day
JK/SK Lexington Campus
Expected Arrival Time Expected Pick-up Time Desired Start Date
Mother's Information
First Name Last Name E-mail Address
Home Phone Work Phone Cell Phone
Check here if home address information is same as child's. If not, please complete below:
Address
City Province Postal Code
Mother's Employer Information
Name of Employer Employer Address
Employer City Employer Province Employer Postal Code
Work Hours Special Contact Instructions
Father's Information
First Name Last Name E-mail Address
Home Phone Work Phone Cell Phone
Check here if home address information is same as child's. If not, please complete below:
Address
City Province Postal Code
Father's Employer Information
Name of Employer Employer Address
Employer City Employer Province Employer Postal Code
Work Hours Special Contact Instructions
Family Information
Parent's Marital Status
Married Common-law Separated Divorced Single Widowed
Parent with legal custody:
Both Mother Father Other:


or print out this form and mail it to us!


Butterfly Learning Centre • 30 Bathurst Dr. • Waterloo, ON N2V 1V6 • Phone 519-880-9021 • info@butterflylearningcentre.com
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