kloriousdaycare@gmail.com
|
780-715-2228
Klorious Kids Learning center (Church Location)
#1 Alberta Dr Fort McMurray, AB T9H 1P3
Family
Family Name
First Parent
Relation to Child
First Name
Last Name
Cell Phone
Home Phone
Address
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Postal Code
Work Name
Work Phone
Work Address
Email Address
By providing your email address you are implying consent to receive occassional email messages from our centre
Second Parent
Relation to Child
First Name
Last Name
Cell Phone
Home Phone
Address
City
Province
AB
BC
MB
NB
NL
NT
NS
NU
PE
SK
ON
QC
YT
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
VI
WA
WV
WI
WY
Postal Code
Work Name
Work Phone
Work Address
Email Address
By providing your email address you are implying consent to receive occassional email messages from our centre
First Child
Given Name
Last Name
Goes By
Birthdate
Sex
Male
Female
Living Arrangements
Child lives with
Mother
Father
Other
Other Guardian
Is there a custody agreement?
No
Yes
Custody Agreement Notes
Enrolment
Desired Start Date
Frequency
Full Time
Part Time
Drop In
Hours
Days
Weeks
Months
per Hour
per Day
per Week
per Month
per Term
per Quarter
per Year
Medical
Health Care #
Physician's Name
Physician's Phone
Diet Restrictions
Allergies
Other Medical Concerns
Is your child's immunization up to date?
No
Yes
Does your child receive medication on an ongoing basis?
No
Yes
Medication Details
Subsidy
Subsidy is approved
Amount Approved
I have applied for subsidy
Application Date
I will apply for subsidy
I need help applying for subsidy
I do not plan to apply for subsidy
Other questions, comments or notes
Second Child
Given Name
Last Name
Goes By
Birthdate
Sex
Male
Female
Living Arrangements
Child lives with
Mother
Father
Other
Other Guardian
Is there a custody agreement?
No
Yes
Custody Agreement Notes
Enrolment
Desired Start Date
Frequency
Full Time
Part Time
Drop In
Hours
Days
Weeks
Months
per Hour
per Day
per Week
per Month
per Term
per Quarter
per Year
Medical
Health Care #
Physician's Name
Physician's Phone
Diet Restrictions
Allergies
Other Medical Concerns
Is your child's immunization up to date?
No
Yes
Does your child receive medication on an ongoing basis?
No
Yes
Medication Details
Subsidy
Subsidy is approved
Amount Approved
I have applied for subsidy
Application Date
I will apply for subsidy
I need help applying for subsidy
I do not plan to apply for subsidy
Other questions, comments or notes
Third Child
Given Name
Last Name
Goes By
Birthdate
Sex
Male
Female
Living Arrangements
Child lives with
Mother
Father
Other
Other Guardian
Is there a custody agreement?
No
Yes
Custody Agreement Notes
Enrolment
Desired Start Date
Frequency
Full Time
Part Time
Drop In
Hours
Days
Weeks
Months
per Hour
per Day
per Week
per Month
per Term
per Quarter
per Year
Medical
Health Care #
Physician's Name
Physician's Phone
Diet Restrictions
Allergies
Other Medical Concerns
Is your child's immunization up to date?
No
Yes
Does your child receive medication on an ongoing basis?
No
Yes
Medication Details
Subsidy
Subsidy is approved
Amount Approved
I have applied for subsidy
Application Date
I will apply for subsidy
I need help applying for subsidy
I do not plan to apply for subsidy
Other questions, comments or notes
Emergency Contacts
(Other than parents)
Relation to Child
First Name
Last Name
Cell Phone
Home Phone
Address
City
Province
AB
BC
MB
NB
NL
NT
NS
NU
PE
SK
ON
QC
YT
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
VI
WA
WV
WI
WY
Postal Code
Authorized for Pickup
Relation to Child
First Name
Last Name
Cell Phone
Home Phone
Address
City
Province
AB
BC
MB
NB
NL
NT
NS
NU
PE
SK
ON
QC
YT
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
VI
WA
WV
WI
WY
Postal Code
Authorized for Pickup
Agreements
Sunscreen Application
I hereby authorize Klorious Daycare staff to apply sunscreen (provided by parents) on my child in spring and summer as needed.
Himama
By signing this form you grant permission for us to photograph or video your child for the purposes of sharing this information with you through the Program. You will also receive updates and information about your child through the Program to the email you have provided herein. Note that sometimes other children in the center may feature in photos, videos or stories of your child. By giving your consent you agree not to share photos or video of any child, other than your own, outside the Program without permission.
Media
My child’s pictures/ video can be used on the center’s website or/and social media
Evacuation
In the case of an emergency evacuation like fire, flood, gas leak, chemical spill or any natural disaster, I give permission for my child listed above to be relocated to another site as deemed necessary. I understand that transportation or walking may be required
Illness
If center staff notifies me that my child is ill, I will pick up my child as soon as possible and no later than one (1) hour after being contacted. If my child contracts a contagious illness, I understand that my child may return only when he or she is well, as described in the Parent Handbook.
Center Hours
Center is open Monday to Friday ( Saturday and Sunday for extended care ) The center will be closed New Year’s Day, Alberta Family Day, Good Friday, Easter Monday, Victoria Day, Canada Day, Labour Day, Thanksgiving Day, Remembrance Day, Christmas Day . We also dedicate days between Christmas and New Year every year for professional development. The center will be closed these training days. The center will be open whenever possible on a regularly scheduled day, except in the case of severe weather or other emergencies. Tuition is not reduced as a result of center closures
COVID-19 Government Guidelines
I have read the Government of Alberta COVID-19 GUIDELINES and I agree to abide by all policies and procedures. I understand protocols are subject to change as the situation evolves.
Assessments and Screenings
I give permission for my child to participate in early learning assessments and screenings administered by Klorious Kids. The results of these assessments will be used to measure my child’s progress and may be used to evaluate and update the center's programs. I will have access to all results of these assessments.
Communication
I give KKD permission to communicate with me by telephone, text, e-mail, or other means. I understand KKD’s privacy policy applies to the information I provide
Insect Repellent Application
I hereby authorize Klorious Daycare staff to apply insect repellent (provided by parents) on my child in spring and summer as needed.
Photographic Release
I give permission for my child to be photographed and videoed in the center and during program functions and field trips. I understand that photographs/videos may be taken by center staff or by other parents/guardians, and I consent to the use of these photographs/videos for communication purposes, such as communication with families and internal business communications.
Field Trips & Neighbourhood Walks
I understand that field trips and walks to neighbourhood areas and parks are part of the programming at Klorious Daycare and I hereby give consent for my child to participate in these activities.
Medical Authorization
In the event that I can not be reached and emergency medical treatment is required for my child, I hereby agree to allow the Director or staff of Klorious Daycare to seek any medical treatment appropriate. I agree to be responsible for any costs incurred as a result of this medical treatment.
Telephone Number Release
Other parents sometimes request a family's phone number so they can phone to invite your child to a birthday party or some other social event. Please sign below if you have no objections to the release of your phone number for this purpose.
Wrap up
How did you first hear about us?
Facebook
Instagram
Print Directory
Alberta Government Website
Web Search
Word of Mouth (referral)
Drive by (saw the signs)
Others
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