Registration

First Parent

Relation to Child

First Name

Last Name

Cell Phone

Home Phone

Address

City

Province

Postal Code

Work Name

Work Phone

Work Address

Birthdate

Email Address

Second Parent

Relation to Child

First Name

Last Name

Cell Phone

Home Phone

Address

City

Province

Postal Code

Work Name

Work Phone

Work Address

Birthdate

Email Address

First Child

Second Child

Third Child

Emergency Contacts (Other than parents)

Relation to Child

First Name

Last Name

Cell Phone

Home Phone

Address

City

Province

Postal Code

Authorized for Pickup

Relation to Child

First Name

Last Name

Cell Phone

Home Phone

Address

City

Province

Postal Code

Authorized for Pickup

Agreements

Permission to Share Information

I give permission for the BCS Childcare Services to share information, regarding my child, with other representatives in BCS - and possibly agents outside BCS -to help assess, or collaborate with those who work directly with my child to enhance their experience here at BCS.

Epi Pen

I hereby agree to allow the Director or staff of BCS-Childcare Services to administer my child's Epi Pen if he/she is having a severe reaction.

Photographic Release

I hereby consent to and authorize BCS - Childcare Services to use and reproduce photographs taken of my child to circulate same for advertising and display purposes of every description - please note these pictures will only be used within BCS - unless granted separate permission for other events.

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 BCS - Childcare Services to seek any medical treatment appropriate. I agree to be responsible for any costs incurred as a result of this medical treatment.

Wrap up