Registration Form

Date of Admission*

Child's Name*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Birthdate*

Mother’s Name*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Phone*

Bus/Cell #

Email*

Employment*

Hours*

Father’s Name*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Phone*

Bus/Cell #

Email

Employment*

Hours*

Emergency Contact Persons (other than parents)

Name*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Phone home*

Phone work*

Name*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Phone home*

Phone work*

Child’s Doctor

Name*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Phone

Alberta Health number #

Child on any medication at home:*

Yes
No

If yes then what type

and what for

Allergies

Special Needs or medical concerns (operations)

Immunization Record

Is your child’s immunization up to date?

Background of Child

Had the child had any of the following illnesses?

Red measles

YES
NO

German measles

YES
NO

Chicken pox

YES
NO

Whooping cough

YES
NO

Mumps

YES
NO

Heart trouble

YES
NO

Convulsions (not epilepsy)

YES
NO

Epilepsy

YES
NO

Head injury

YES
NO

Accidental poisoning

YES
NO

Removal of tonsils

YES
NO

Eye surgery

YES
NO

In the last year had the child had any of the following?

Difficulties with speech

YES
NO

Difficulty with hearing

YES
NO

Difficulty with eyesight

YES
NO

3 or more earaches

YES
NO

Feeding/sleep problems

YES
NO

Daytime or bedwetting

YES
NO

Please list any other information that you considered is or will be relevant:

Authorized persons to whom the child may be released:

Child will not be released to anyone that is not listed on the authorization form, if you want to name anybody please fill the name address and telephone number of those additional pickup authorized personal

1.

2.

3.

Field Trip

I hereby grant permission for my child to accompany his/her group on field trips and neighborhood walks, which staff plans as part of the program. I also understand that I will be informed in advance, verbally, by letter, or by poster on the parent’s board, of any field trip.

Immunization Record

Is your child’s immunization up to date?

YES
NO

(If it’s No then what’s the reason? Also if required you have to provide the detail of immunization to the daycare authorities).

Medical Attention

I release Forest heights childcare & OSC of liability for accidents or illnesses occurring to my child while he is in their care at their centre. In the event of an emergency when I cannot be reached, I give my permission for any medical procedure deemed necessary by my doctor or by another doctor/ physician selected by the centre. I understand that I remain responsible for expenses incurred by this attention and I also give them permission to transport my child to emergency if required in their daycare van.

Policy on Child Development

When children are lacking on some area in developmental areas, the teacher talk to the parent and provide them with resources that can be helpful to them or ask to see their doctor for help. The Daycare center uses nippsing as one of the tool to assess child development. Please provide any child development assessment or interest if you have in particular in your mind to the director or to the staff concerned.

Forest heights childcare & OSC Policy Nondiscrimination:

We will not discriminate in relation to admissions of any child on the basis of race, creed, color, national origin, religion, sex, or disability.

All Parents Please Note the Following:

All fees must be paid first of the month.
One month’s notice must be given for children leaving day-care.
Hours of daycare are from 7:00a.m. To 6:00p.m. Only. Please phone the daycare if you know you will be delayed in picking up your child. Also there will be an extra charge of five dollarsfor every 5 minutes late after 6:00p.m. Which should be paid to the staff that stays late?
No shoes past the foyer. This means children and parents. The children will be taught by example here, to have respect for themselves and each other. They will also be taught to respect our property and possessions.
Any negative behavior will not be allowed. This includes but is not limited to: hitting, punching, kicking, biting, throwing anything at friends, bad language, etc.
A sick child must not be brought to daycare. It is unfair to your child and the other children. If your child shows symptoms of an illness that we are uncertain of, we will request that you bring a doctor’s note stating that your child is able to attend daycare.
Do not send your child to daycare in “dress clothes”. Play clothes only. Although we will try our best to keep children clean, even in the best of circumstances…accidents happen
Holiday parents are allowed twenty dollars off their regular fee per week. Maximum three weeks.
Make sure your child has a complete change of clothing here at all times, including underwear and socks. Please provide a different change of clothes should the one here be used or if the season changes.
Quiet Time: every day between 12:15-2:15 pm, we have quiet time. All younger children will lay down to rest. Older children will be given quiet time activities (coloring supplies, puzzles, etc.)
Items from home, your child may bring a special blanket or stuffed animals for quiet time. Please do not allow your child to bring anything else into the daycare setting. No toys, candy, money, etc.

I hereby agree to abide with all the daycare rules and to inform staff of any of my child’s problems that may arise in future.

Note: That center has open door policy for any suggestions and inputs.

Information Release Agreement

I hereby give permission to display my child’s name on the following:

My child’s cubby and coat hook
My child’s pictures on posters showing various activities in daycare
Any art work
Any birthday related activities
Allergies list
Field Trip Permission List
School list i.e. Listing name, phone # parent name, teacher name, school name etc
Materials brought from home
Medication Information
Or any other place as may be suited by the room staff or director of the daycare for which I have no objection at all.

Comments if any you would like to give or share with us

Additional information

Has your child has experience playing with other children?

Please give us brief description of your child’s behavior. Is he/she friendly by nature, aggressive, shy, withdrawn, imaginative, demanding, etc?

What language(s) are spoken at home?

Signs of child’s tiredness

Child’s fears

Disciplinary measures at home?

Child reaction to illness: Will child tell staff?

Child’s reaction to stress

Is child toilet trained

Does your child have any security objects such as blanket, soother, bottle, toy, etc.?

Age your child began to:

A. Sit

B. Crawl

C. Walking

Were there any difficulties with speech? If yes, please specify

What is your child’s favorite food?

What food does your child dislike?

Are there any food restrictions? If yes, please specify

Child’s favorite color

Child’s favorite song

What are your hopes/ expectations for your child here?