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PRESCHOOL CHILD IDENTIFICATION

    Child's Name*

    Child's Birthdate*

    Child's Eye Colour*

    Child's Hair Colour*

    Child's Skin Colour/Ethnicity*

    Parent's Signature*

    Date*

    Attach Photo of Child

    PRESCHOOL EMERGENCY RECORD

      Child's Name

      D.O.B

      Gender

      Address

      Postal Code

      Health Care #

      Parent(s)

      Home #

      Work/school #

      Emergency Contacts

      Home #

      Work/school #

      Physician

      Office #

      Address

      Allergies

      Health Problems

      In case of accident, injury or illness, i authorize to contact a physician and/or ambulance and to seek medical attention for my child. I also consent for my child to be transported by ambulance or in a staff vehicle to obtain medical attention.

      Parent's Signature*

      Date*

      PRESCHOOL REGISTRATION

        Child's Name*

        Birthdate*

        Nickname

        Sex

        Age

        Yrs

        Mos

        Enrollment Date*

        Withdrawal Date*

        Mailing Address

        Street Address

        Email Address

        Mother's Name

        Home #

        Cell #

        Work #

        Father's Name

        Home #

        Cell #

        Work #

        Parent's Occupation

        Languages spoken at home

        Person to call in case of accident (other than parents listed above)

        Phone #

        Persons authorised to pick up child from facility (other than parent/guardian)

        Name

        Relationship to child

        Phone #

        Name

        Relationship to child

        Phone #

        Name

        Relationship to child

        Phone #

        Family Physician

        Phone #

        Personal Health Number

        Child Immunization

        Rubella

        Health

        General

        Allergies

        Any Allergy/Reactions/Treatments

        Illness or Medical Treatments

        Is there anyone not permitted to pick up your child?

        Family

        Adults at home

        Siblings

        Pets

        Child's previous experience in a playgroup?

        Child's special likes

        What do you hope your child will gain from preschool?

        If there is a custody agreement, please give details. A copy of the custody order must be left with the preschool staff.

        Signature*

        Date*

        Would you like some information about Preschool Subsidy for Fees?

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