mail@activeexplorers.ca
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14034701621
Active Explorers Preschool
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
Child's First Language
Do you have any concerns regarding behaviours?
Do you have any concerns regarding speech and language?
Do you have any concerns regarding your child's hearing?
Do you have any concerns regarding your child's vision?
Living Arrangements
Child lives with
Mother
Father
Other
Other Guardian
Is there a custody agreement?
No
Yes
Custody Agreement Notes
Enrolment
Desired Start Date
Room
Mini Explorers 2
Junior Explorers (Combined Age Class PM)
Explorers 1: 4 Year Old (AM)
Explorers 2: 4 year old (PM)
Friday AM
Mini Explorers 1
Junior K (PM)
Medical
Health Care #
Physician's Name
Physician's Phone
Diet Restrictions
Allergies
Other Medical Concerns
Does your child receive medication on an ongoing basis?
No
Yes
Medication Details
Diet Restrictions:
Is there any other information we should know about your child? Relevant Health - (PAST/PRESENT)?
Does your child have any allergies (eg. food, insect bites...)? Briefly describe typical reactions.
Does your child require any medications (Only emergent medications will be administered at preschool).
Immunization (Yes/No) If no, explain (health, choice...).
Other health problems that could pose an emergency situation (eg.Diabetes, epilepsy...).
Second Child
Given Name
Last Name
Goes By
Birthdate
Sex
Male
Female
Child's First Language
Do you have any concerns regarding behaviours?
Do you have any concerns regarding speech and language?
Do you have any concerns regarding your child's hearing?
Do you have any concerns regarding your child's vision?
Living Arrangements
Child lives with
Mother
Father
Other
Other Guardian
Is there a custody agreement?
No
Yes
Custody Agreement Notes
Enrolment
Desired Start Date
Room
Mini Explorers 2
Junior Explorers (Combined Age Class PM)
Explorers 1: 4 Year Old (AM)
Explorers 2: 4 year old (PM)
Friday AM
Mini Explorers 1
Junior K (PM)
Medical
Health Care #
Physician's Name
Physician's Phone
Diet Restrictions
Allergies
Other Medical Concerns
Does your child receive medication on an ongoing basis?
No
Yes
Medication Details
Diet Restrictions:
Is there any other information we should know about your child? Relevant Health - (PAST/PRESENT)?
Does your child have any allergies (eg. food, insect bites...)? Briefly describe typical reactions.
Does your child require any medications (Only emergent medications will be administered at preschool).
Immunization (Yes/No) If no, explain (health, choice...).
Other health problems that could pose an emergency situation (eg.Diabetes, epilepsy...).
Third Child
Given Name
Last Name
Goes By
Birthdate
Sex
Male
Female
Child's First Language
Do you have any concerns regarding behaviours?
Do you have any concerns regarding speech and language?
Do you have any concerns regarding your child's hearing?
Do you have any concerns regarding your child's vision?
Living Arrangements
Child lives with
Mother
Father
Other
Other Guardian
Is there a custody agreement?
No
Yes
Custody Agreement Notes
Enrolment
Desired Start Date
Room
Mini Explorers 2
Junior Explorers (Combined Age Class PM)
Explorers 1: 4 Year Old (AM)
Explorers 2: 4 year old (PM)
Friday AM
Mini Explorers 1
Junior K (PM)
Medical
Health Care #
Physician's Name
Physician's Phone
Diet Restrictions
Allergies
Other Medical Concerns
Does your child receive medication on an ongoing basis?
No
Yes
Medication Details
Diet Restrictions:
Is there any other information we should know about your child? Relevant Health - (PAST/PRESENT)?
Does your child have any allergies (eg. food, insect bites...)? Briefly describe typical reactions.
Does your child require any medications (Only emergent medications will be administered at preschool).
Immunization (Yes/No) If no, explain (health, choice...).
Other health problems that could pose an emergency situation (eg.Diabetes, epilepsy...).
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
Active Explorers Policies
I have read, understood and I agree to comply with all teh policies of Active Explorers Preschool Inc. I understand that Active Explorers reserves the right to release my child from the program if there is a failure to comply witih the guidelines in the Parent Handbook.
Photos for Online Media
I hereby consent to and authorize Active Explorers Preschool to use and reproduce photographs taken of my child to use for display on our website and any online social media platform.
Photos Inside the Centre
I hereby consent to and authorize Active Explorers Preschool to use and reproduce photographs taken of my child to post inside the centre.
Neighbourhood Walks
I give Active Explorers permission to leave the school premises under the supervision of Active Explorers Inc. staff for nature walks to the field area behind the Calgary Humane Society. I understand that my child will be supervised at all times and that regulated staff/child ratio will be maintained at all times. I understand that there are risks associated with the activities named above. Any other special excursions that rely on alternative transportation will require a separate consent form to be filled out and signed before the planned special excursion.
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 Active Explorers Preschool to seek any medical treatment appropriate. I agree to be responsible for any costs incurred as a result of this medical treatment.
Wrap up
How did you first hear about us?
Alberta Government Website
Web Search
Word of Mouth (referral)
Drive by (saw the signs)
Other
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