Call: 403-248-8181

Registration Form

Daycare Licensing Regulations do not permit us to care for your child until we have this completed Enrollment Record on file. Please print clearly; use pen. Answer all questions and attach copies of your current Alberta Health Care Card and your child’s up to date immunization record. Please advise director immediately of any changes in phone numbers, addresses, immunizations, allergies etc.

SECTION 1

A. CHILD’S INFORMATION

Child’s Name
Date Of Birth
Gender
Home Phone #
Name Child prefers to be called
Child’s Home Address
Postal Code
Child’s attendance Schedule
(Full/Part time)
Child’s drop off time
Child’s pick up time

B. GUARDIAN INFORMATION/MOTHER

Mother/Guardian
Occupation
Employed by
Work Address
Working Hours
Home Address
Postal Code
Work Phone #
Cell Phone #
Home Phone #
Email address
Marital Status

C. GUARDIAN INFORMATION /FATHER

Father / Guardian
Occupation
Employed By
Work Address
Working Hours
Home Address
Postal Code
Work Phone#
Cell Phone #
Home Phone #
Email Address
Marital Status

D. FAMILY BACKGROUND

Mother Home Country
Mother’s Home Language
Father’s Home Country
Father’s Home Language
Child’s Home Country
Child’s Home Language
If parents are divorced or separated, how
long?
Child’s adjustment to this
Please notify who is responsible for payments and fees
Custody arrangements: (Provide Court Orders)
Person not allowed to pick up the child

E. ALTERNATE EMERGENCY CONTACT

Name
Phone
Relation to child
Work Phone #
Address
Can pick all children in the family:
Codeword to be used by persons picking up your child

F. FAMILY LIVING AT HOME OTHER THAN PARENTS AND SIBLINGS

Name
Age
Relation to
child
Name
Age
Relation to
child

G. EATING HABITS

Describe general appetite of your child
Is there anything we should know about what or how he/she eats?
Please mention feeding schedule, food already introduced, food to be introduced, special instructions and habit.

H. SOCIAL DEVELOPMENT

How would you describe your child’s personality?
Does your child sleep?:
Previous Daycare

I. HEALTH INFORMATION

Alberta Health Care Number
Doctor’s Name
Telephone
Address
Immunization is updated:

J. CHILDHOOD ILLNESS

Allergies: (Specify)
Other Dietary restrictions
Childhood illness (if any)
Hospitalization:
(Date and Diagnosis)
Has your child had any medical or condition requiring or receiving treatment Or supervision?:
If yes please describe
Is your child on ongoing medication:
If yes what kind?

SECTION 2

A. PERMISSIONS AND ACKNOWLEDGEMENTS

   I Agree



B. FOR DIRECTOR’S USE

Today’s Date
Commencement Date
Withdrawal Date
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