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

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

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

Do you have children you'd like to pre-register for the future?

Grade Level

Kindergarten Care Level

Out of School Care Level

Living Arrangements

Child lives with

Mother

Father

Other

Other Guardian

Is there a custody agreement?

No Yes

Custody Agreement Notes

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

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

Medical Symptoms and Notes

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