Shine Afterschool Care Program Waitlist

Please note: Priority is given to those requiring full-time care.

Select Location

Please select Shine Afterschool Care location

Child #1 Information

First Name*

Middle Name

Name*

Birth Date*

Age*

Gender*

Child #2 Information

First Name

Middle Name

Name

Birth Date

Age

Gender

What date would you like your child to start at Shine?

Please Select Date

Program Days

Please select the days you want your child to attend Shine.

Full Time – Monday to Friday

3 Days a Week – Monday, Wednesday, and Friday

2 Days A Week – Tuesday and Thursday

Mother's Information

Mother's First Name*

Mother's Last Name*

Mother's Phone Number*

Mother's Email Address*

Father's Information

Father's First Name*

Father's Last Name*

Father's Phone Number*

Father's Email Address*

Home Address

Street*

City*

Postal Code

Mailing Address
(if different from above)

Mailing Address
City

Mailing Address
Postal Code

Comments

Please add any other information you would like us to know.