Application
Please complete the form below and click submit.
Parent/Guardian Information
First Name
*
Last Name
*
Relationship
*
- Select One -
Mother
Father
Grandmother
Grandfather
Guardian
Joint Custody
Other
Address
*
Email
*
Phone
*
Child Information
First Name
*
Last Name
*
Date of Birth
*
Req. Start Date
*
Location
Langley - Walnut Grove
19950 88th Ave East
Langley, BC
V1M 0A5
604 881 2332
Secure Payment
Application Fee
$100.00
Name On Card
Credit Card
Submit
Application Successful
Your application has been received.