info@strathconanurseryschool.com
|
780-432-9226
Strathcona Nursery School
Online Registration
Family
Family Name
First 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
Birthdate
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
Birthdate
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
Are there any specific custody or access rights that Strathcona Nursery School should be aware of? Please enter No or provide details.
List of persons authorized to pick up your children: Please enter No or provide the names and relationship to your child(ren), of all persons authorized to pick up your child(ren) from Strathcona Nursery School (do not include parents names):
1 Monday AM
2 Monday PM
3 Tuesday AM
4 Tuesday PM
5 Wednesday AM
6 Wednesday PM
7 Thursday AM
8 Friday AM
9 Friday PM
Living Arrangements
Child lives with
Mother
Father
Other
Other Guardian
Is there a custody agreement?
No
Yes
Custody Agreement Notes
Enrolment
Desired Start Date
Medical
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
Does your child carry an epi-pen or other emergency medications? Please enter No, or provide 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
Second Child
Given Name
Last Name
Goes By
Birthdate
Sex
Male
Female
Are there any specific custody or access rights that Strathcona Nursery School should be aware of? Please enter No or provide details.
List of persons authorized to pick up your children: Please enter No or provide the names and relationship to your child(ren), of all persons authorized to pick up your child(ren) from Strathcona Nursery School (do not include parents names):
1 Monday AM
2 Monday PM
3 Tuesday AM
4 Tuesday PM
5 Wednesday AM
6 Wednesday PM
7 Thursday AM
8 Friday AM
9 Friday PM
Living Arrangements
Child lives with
Mother
Father
Other
Other Guardian
Is there a custody agreement?
No
Yes
Custody Agreement Notes
Enrolment
Desired Start Date
Medical
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
Does your child carry an epi-pen or other emergency medications? Please enter No, or provide 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
Third Child
Given Name
Last Name
Goes By
Birthdate
Sex
Male
Female
Are there any specific custody or access rights that Strathcona Nursery School should be aware of? Please enter No or provide details.
List of persons authorized to pick up your children: Please enter No or provide the names and relationship to your child(ren), of all persons authorized to pick up your child(ren) from Strathcona Nursery School (do not include parents names):
1 Monday AM
2 Monday PM
3 Tuesday AM
4 Tuesday PM
5 Wednesday AM
6 Wednesday PM
7 Thursday AM
8 Friday AM
9 Friday PM
Living Arrangements
Child lives with
Mother
Father
Other
Other Guardian
Is there a custody agreement?
No
Yes
Custody Agreement Notes
Enrolment
Desired Start Date
Medical
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
Does your child carry an epi-pen or other emergency medications? Please enter No, or provide 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
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
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