Le Petit Chaperon Rouge, garderie francophone
419 Avenue Coxwell
Toronto M4L 3B9
416-463-3955
École Georges-Etienne-Cartier
250, chemin Gainsborough
Toronto M4L 3C6
416-465-2582
École La Mosaïque
80, avenue Queensdale
Toronto M4J 1Y3
416-463-3975
École Ste-Marguerite d’Youville
755, chemin Royal York
Etobicoke M8Y 2T3
416-236-4557
École Richview
59, chemin Clement
Etobicoke M9R 1Y5
416-236-4557
École du Sud-Est de Toronto (St. William)
343, avenue Jones
Scarborough M4J 3G4
416-465-2227
APPLICATION FORM
CHILD
LAST NAME:
APT:
FIRST NAME:
STREET:
DATE OF BIRTH
DAY :
CITY:
MONTH :
PARENT 1
LAST NAME:
APT:
YEAR :
AGE :
FIRST NAME:
STREET:
TELEPHONE Home :
TELEPHONE Work :
TELEPHONE Cell:
EMAIL ADDRESS:
PARENT 2
LAST NAME:
APT:
POSTAL CODE:
CITY:
POSTAL CODE:
NAME OF EMPLOYER:
ADDRESS:
FIRST NAME:
STREET:
TELEPHONE Home :
TELEPHONE Work :
TELEPHONE Cell:
EMAIL ADDRESS:
CITY:
POSTAL CODE:
NAME OF EMPLOYER:
ADDRESS:
PERSONS TO CONTACT IN CASE OF EMERGENCY
NAME
TEL HOME :
ADDRESS:
TEL WORK :
NAME
TEL HOME :
ADDRESS:
TEL WORK :
PERSONS AUTHORIZED TO COME PICK UP THE CHILD
NAME
TEL HOME :
ADDRESS:
TEL WORK :
NAME
TEL HOME :
ADDRESS:
TEL WORK :
ALLERGIES:
SEVERITY OF REACTION :
DIETE:
INFORMATION REGARDING BEHAVIOUR:
OTHERS:
HEALTH CARD NUMBER :
VERSION CODE :
NAME OF DOCTOR OR PEDIATRICIAN :
TEL :
ADDRESS :
FAX :
CONTAGIOUS OR SERIOUS DISEASES:
HAS YOUR CHILD HAD ONE OF THE FOLLOWING CONTAGIOUS DISEASE:

NONE
ROUGEOLE (measles) 
OREILLONS (mumps) 
RUBÉOLE (rubella)  COQUELUCHE (whooping Cough) 
VARICELLE (chicken pox) 
FIÈVRE SCARLATINE (scarlet fever) 
ROSÉOLE (roseola) 
COXWELL 
CENTRE :
ETOBICOKE 
QUEENSDALE 
HÉPATITE (hepatitis) 
GAINSBOROUGH  
RICHVIEW 
SCARBOROUGH 

ADMISSION DATE :

PROGRAM :
FULL TIME :

PART TIME:
DAYS:

UNDER NO CIRCUMSTANCES WILL A CHILD BE LEFT TO A PERSON NON AUTHORIZED BY THE PARENTS
I AM SUSCRIBING THE CHILD MENTIONED ABOVE AT LE PETIT CHAPERON ROUGE DAYCARE. I UNDERSTAND AND FOLLOW ALL RULES OF
THE DAYCARE.
I ACCEPT TO PAY THE FEES REQUIRED IN A TIMELY MANER (FIRST 5 DAYS OF EACH MONTH) OR TO PAY THE LATE FEE PENALTY AS DISCRIBED IN
THE PARENTS’ GUIDE.
SIGNATURE OF PARENT OR GUARDIAN:
DATE:
FOR ADMINISTRATION USE ONLY
DATE D’INSCRIPTION:
DATE D’ADMISSION:
LOCATION:
PROGRAMME:
ACCEPTÉ PAR:
SUBVENTIONNÉ

PER DIEM:
DÉPÔT:
$
FRAIS ADMINISTRATIFS:
$ 40
COTISATION - ANNÉE
DATE DE RETRAIT:
$ 15
DOSSIER :

#
DÉPÔT PAYÉ LE:


FRAIS ADMINISTRATIFS PAYÉS LE:
COTISATION PAYÉE LE:
RAISON: