Child Care Services Application

General Information

Child's first name: *

Child's last name: *

Birth date/Due date: *

Requested date of entry: *

Campus: *

Interurban

Lansdowne

Select all that apply

Do you have a child currently attending Child Care Services?: *

Yes

Primary Caregiver Information

Status: *

Camosun student

Camosun staff

Camosun faculty

Community member

Union: *

Camosun ID: *

Format: C0123456

Program:

Department: *

First name: *

Last name: *

Street address: *

City: *

Province: *

Postal code: *

Format: A1A 1A1

Phone: *

Format: 250-555-1234

Alternate phone:

Format: 250-555-1234

Email: *

This address will be used to communicate with you about the status of your application.
You will receive a confirmation email at this address when you submit this form.

Secondary Caregiver Information

Status:

Camosun student

Camosun staff

Camosun faculty

Community member

Union:

Camosun ID:

Format: C0123456

Program:

Department:

First name:

Last name:

Street address:

City:

Province:

Postal code:

Format: A1A 1A1

Phone:

Format: 250-555-1234

Alternate phone:

Format: 250-555-1234

Email:

Personal information is collected under the legal authority of the College and Institute Act, RSBC, 1996, c. 52 and s. 26(c) of the Freedom of Information and Protection of Privacy Act, RSBC, 1996, c. 165 for administrative and operational purposes of the College, and/or the ministries or agencies of the Province of British Columbia (BC) and the Government of Canada. The information that you provide is protected, used and disclosed in compliance with these purposes and BC privacy legislation. If you have any questions about the protection of your personal information, please review Camosun College’s Privacy Policy, or email privacy@camosun.ca

Online Forms

Child Care Services Application