info@kidzonechildcare.ca
|
780-756-5440
Kidzone Daycare & OSC
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
Email Address
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
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
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
Daycare
OSC
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
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
Daycare
OSC
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
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
Daycare
OSC
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 Kidzone Daycare & OSC staff to apply sunscreen (provided by parents) on my child in spring and summer as needed.
Insect Repellent Application
I hereby authorize Kidzone Daycare & OSC staff to apply insect repellent (provided by parents) on my child in spring and summer as needed.
Photographic Release
I hereby consent to and authorize Kidzone Daycare & OSC to use and reproduce photographs taken of my child to circulate same for advertising and display purposes of every description
Field Trips & Neighbourhood Walks
I understand that field trips and walks to neighbourhood areas and parks are part of the programming at Kidzone Daycare & OSC 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 Kidzone Daycare & OSC to seek any medical treatment appropriate. I agree to be responsible for any costs incurred as a result of this medical treatment.
Transportation to and from School
I hereby consent and authorize Kidzone Daycare & OSC to walk my child to/from school, supervised by the Director and/or staff of Kidzone Daycare & OSC.
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?
Print Directory
Alberta Government Website
Web Search
Word of Mouth (referral)
Drive by (saw the signs)
Other
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