Registration

First Parent

Relation to Child

First Name

Last Name

Cell Phone

Home Phone

Address

City

Province

Postal Code

Personal Email Address

Work Name

Work Phone

Second Parent

Relation to Child

First Name

Last Name

Cell Phone

Home Phone

Address

City

Province

Postal Code

Personal Email Address

Work Name

Work Phone

First Child

Given Name

Last Name

Goes By

Birthdate

Sex

Child lives with

Mother

Father

Other

Is there a custody agreement?

No
Yes

School
Please enter school details as you expect them to be on your child's start date

Not in school
Attending kindergarten
Attending grade 1 to 6

School Name

Enrolment

Desired Start Date

Program

Medical

Health Care #

Physician's Name

Physician's Phone

Diet Restrictions

Allergies

Other Medical Concerns

Are your child's immunizations up to date?

No
Yes

Does your child require medication, or carry emergency medication?

No
Yes

Subsidy

Subsidy is approved

I have applied for subsidy

I will apply for subsidy

I need help applying for subsidy

I do not plan to apply for subsidy