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Lillio formerly HiMama
Submit a request for childcare at Rendell Park

Fill out this application form to request a spot for your child at Rendell Park.

Child information
First name
Last name
Date of birth
Select gender
Child's primary address
Street address
Address line 2 (optional)
City
State / province
Select
ZIP / postal code
Parent/Guardian information

Primary applicant

First name
Last name
Select
Email
Retype email
Phone number
Emergency contacts
Emergency contact 1
Full name
Select
Phone number
Allergy and medical notes
Enrollment information
Preferred start date
Preferred time of day
Preferred weekly schedule
Additional notes(optional)

Please provide details to assist with selection (ie. part-time/full-time care, preferred schedule, subsidy needs, siblings attending the center etc.)

Max 400 characters