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
CEFA Nanaimo BC
1815 Bowen Rd
Nanaimo, BC
BC V9S 1H1
250 755 6502
Submit
Application Successful
Your application has been received.
