Thanks very much James, it gives me great pleasure to be here this
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University Settlement Over 100 Years of Service in the Community P# 416-598-3444 F# 416-598-4401 DAYCARE APPLICATION FORM Have you applied for financial assistance? YES NO Has your subsidy been approved? YES NO Would you be willing to pay full fees if subsidy in not approved? UNCERTAIN YES NO Date of Application: _________________________ Date Care Is Required: _______________________________ Name of Child: _____________________________ Child’s Date of Birth: ________________________________ Name of Parent (#1): _________________________ Name of Parent (#2): __________________________________ Home Address: _____________________________ Home Address:_______________________________________ Home Phone No: ____________________________ Home Phone No: _____________________________________ Business Phone No: __________________________ Business Phone No: ___________________________________ Cell/Pager No: ______________________________ Cell/Pager No: _______________________________________ Email Address: _____________________________ Email Address: ______________________________________ Additional Comments: ______________________________________________________________________________ **Please contact the US within six months to renew your application and check your status. If contact is not made, your name will be removed from the waiting list.** University Settlement Over 100 Years of Service in the Community P# 416-598-3444 F# 416-598-4401 DAYCARE APPLICATION FORM Have you applied for financial assistance? YES NO Has your subsidy been approved? YES NO Would you be willing to pay full fees if subsidy in not approved? YES UNCERTAIN NO Date of Application: _________________________ Date Care Is Required: _______________________________ Name of Child: _____________________________ Child’s Date of Birth: _________________________________ Name of Parent (#1): _________________________ Name of Parent (#2): _________________________________ Home Address: _____________________________ Home Address:______________________________________ Home Phone No: ____________________________ Home Phone No: ____________________________________ Business Phone No: _________________________ Business Phone No: __________________________________ Cell/Pager No: ______________________________ Cell/Pager No: ______________________________________ Email Address: _____________________________ Email Address: ______________________________________ Additional Comments: ______________________________________________________________________________ **Please contact the US within six months to renew your application and check your status. If contact is not made, your name will be removed from the waiting list.**
