Registration « Regina Early Learning Centre

Please Join Our Waitlist

Regina Early Learning Centre

2115 Athol Street

Childcare Waitlist Form Program Information

Hours of Operation

Monday to Friday
7:30 a.m. – 5:30 p.m.
Closed on all Saskatchewan Statutory Holidays

Programs Available

Toddler Program (18 months–30 months) – 10 spaces
Preschool Program (30 months to school age) – 38 spaces

Fees: $217.50 per month

Fees are due on the 1st day of each month for the upcoming month.

Accepted payment methods:

Cash
Cheque
E-transfer

"*" indicates required fields

Company

This field is for validation purposes and should be left unchanged.

Child Information

Child's Full Name*

First Last

Preferred Name (if different)

Date of Birth*

Gender (Optional)

Male

Female

Non-binary

Prefer to self-describe

Prefer not to say

Please specify:*

Home Address*

Street Address Address Line 2 City Province Postal Code

Parent/Guardian Information

Parent/Guardian #1*

First Last

Relationship to Child*

Phone*

Email*

Employer (Optional)

Parent/Guardian #2 (Optional)

First Last

Relationship to Child

Phone

Email

Employer (Optional)

Preferred Method of Contact*

Phone

Email

Text Message

Program Request

Which program are you requesting?*

Toddler (18–30 months)

Preschool (30 months to school age)

Requested Start Date

Days Required*

Monday

Tuesday

Wednesday

Thursday

Friday

Schedule Needed*

Full-Time

Part time (Please Specify)

Part Time Details

Child Information

Is your child toilet trained?

Yes

No

Currently learning

Does your child have any allergies?*

No

Yes (Please Describe)

Describe Allergies

Dietary Restrictions

Please list any dietary restrictions, food sensitivities, or cultural/religious food requirements.

Medical Information

Does your child have any medical conditions or diagnoses we should be aware of? (Ex. Asthma, Diabetes, Autism, ADHD, Epilepsy, etc.)

Behavioural or Developmental Information

Is there anything you would like us to know about your child's behaviour, emotional regulation, learning style, or developmental needs so we can best support them?

Does your child receive support services?*

No

Yes

If yes, please indicate:*

Speech Language

Occupational Therapy

Physical Therapy

Autism Services

Behavioural Support

Other

Does your child require medication while attending childcare?*

No

Yes (Please Explain)

If yes, please explain:*

Family Information

Has your child previously attended childcare?

Yes

No

If yes, please describe where:*

How did you hear about us?

Additional Information

Is there anything else you would like us to know about your child or family?

Consent*

I understand that: Submission of this registration form does not guarantee placement. Spaces are limited and are offered based on availability and program eligibility. If a space becomes available, Regina Early Learning Centre will contact me to complete the enrolment process. I understand that monthly childcare fees are due on the 1st of each month and may be paid by cash, cheque, or e-transfer.

Yes

Parent/Guardian Name*

Date

Childcare Waitlist Form

Please Join Our Waitlist

Regina Early Learning Centre

Childcare Waitlist Form Program Information

Hours of Operation

Programs Available

Fees: $217.50 per month

Child Information

Parent/Guardian Information

Program Request

Requested Start Date

Child Information

Family Information

Additional Information

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