Please complete this registration form in order to place your child's name on the waiting list. You will recieve a confirmation e-mail once the application is submitted with a reference number and a summary of your submission. We will contact you within 2 to 5 working days. Thank you for your interest in Garderie Maison Arc-En-Ciel.   

Registration
Name
Relation	Mother Father Other
Child Name
Child date of birth	DD-MM-YYYY
Home Phone	XXX-XXX-XXXX
Mobile or Work	XXX-XXX-XXXX
email
Address
Location	Maison Arc-En-Ciel I Maison Arc-En-Ciel II Maison Arc-En-Ciel I or II
Start Date	DD-MM-YYYY
	*Maison Arc-En-Ciel near Zig Zag Zoo. *Maison Arc-En-Ciel II near Honda Vaudreuil.