Application Forms

Forms available for download:

Social/Medical Need Referral Form




These forms can be printed by you and then filled out.

If you have any questions, please contact Chera Kuipers at:
(613) 476-2842 ext 108 or Toll free 1-866-476-2842 ext 108

Customer Service at any of the office locations will be happy to assist with photocopying required documents to be submitted with the application.

Completed applications can be dropped off at your local PELASS office:

Picton Office The Armoury, 206 Main Street, Picton, ON  K0K 2T0


Napanee Resource Centre, 95 Advance Avenue, Napanee, ON  K7R 3Y6


Amherstview Office, 20 Manitou Crescent West, Amherstview, ON  K7N 1B4


Housing & ASI Office, #13 Market Square, Napanee, ON  K7R 1J4


Northbrook Office 12309 Hwy. 41, Northbrook, ON  K0H 2G0


Or mail to the following address:
Prince Edward-Lennox & Addington Social Services
Attn: Child Care Department
P.O. Box 1650
Picton, ON  K0K 2T0