Inquiry Form
Please complete the form below and click submit.
Enter your Information:
First Name
*
Last Name
*
Relationship
*
- Select One -
Mother
Father
Grandmother
Grandfather
Guardian
Joint Custody
Other
Email
*
Phone
*
Child Information
First Name
*
Last Name
*
Date of Birth
*
Gender
*
Select One
Male
Female
Other
Unknown
Requested Start Date
*
Add Additional Child
Location Information
Victoria - Westshore
103 - 3030 Merchant Way
Victoria, BC
V9B 0X1
778.265.9986
Referral / Comments
How did you hear about us?
*
- Select One -
Internet Search (Google, etc)
Online Advertising
Word of Mouth (referral, etc)
Print Advertising
Drive By
Facebook
Instagram
WeChat
Outdoor Ads (billboards, etc.)
OurKids
Other
Comment
Submit
Reset
