Complete Form

Please select which program you would like to attend:
Applicant 1: Applicant's Relationship to the Child(ren)
Applicant 2: Applicant's Relationship to the child(ren)
Anticipated Work Days
Does Applicant 1 have the option to work from home?
Anticipated Work Days
Does Applicant 2 have the option to work from home?
Evidence of employment is required for each applicant.  A letter from your employer, paystub or employee badge is acceptable. This is required for all applicants and will allow us to process your application more quickly if it is attached to the application. A photo taken with your phone/camera is sufficient as long as it is legible, so please verify this before uploading the image.
Maximum 4 files.
20 MB limit.
Allowed types: gif jpg jpeg png bmp eps tif rtf pdf doc docx.
If you are unable to upload this information other arrangements can be made when you are contacted by our office.

If you have any questions please contact PELASS Children’s Services Department at 613-354-0957 x 2402 or email childcare@lennox-addington.on.ca.

I confirm understanding of the conditions of PELASS’s emergency child care services as identified in the
Consent Form (click here to view). Further, I give consent for PELASS to collect information regarding the attendance and screening results for all children attending emergency child care services.
Click 'Yes' to provide consent.