Daycare Registration

Daycare Registration

Program: Child Care 3 months - 5years
Child Personal and Contact Information
Child's Name*
Date of Birth *
Gender
Address
Phone No.
Parent Personal and Contact Information
Parent 1
Name*
Address
E-Mail Address
Place of Work
Phones
Home
Cell
Work
Allowed Access
Parent 2
Name*
Address
E-Mail Address
Place of Work
Phones
Home
Cell
Work
Allowed Access
Emergency Contact Information

*An Emergency Contact person is someone OTHER than a parent*

Emergency Contact #1
Name*
Relationship to child*
Address
Place of Work
Work Address
Phones
Home
Cell
Work
Emergency Contact #2
Name*
Relationship to child*
Address
Place of Work
Work Address
Phones
Home
Cell
Work
Child Medical Information
Alberta Health Card Number
Are Immunizations up-to-date
Physician Name
Physician Phone
Physician Address
List Any Allergies Describe Reaction(s) if exposed to allergy
Explain Required Care if exposed to Allergy
List Any Other (non-allergy) Medical Conditions
Special Care… What we need to know
On-Going / Emergency Medications
For What Condition(s)?(including allergies)
Instructions & Dosage *a medication form must be filled out prior to centre administering any medication(s)*
The Following Named ARE Allowed Access to My Child
Name
Relationship To Child
Name
Relationship To Child
Name
Relationship To Child
Name
Relationship To Child
  • Children will NOT be released to anyone who has not been authorized by the parent
  • A phone call from a parent to change/add an authorized person will be allowed only if the parent can answer security (personal and/or centre related) questions to confirm their identity
  • Anyone picking up a child must have authorization and government issued picture identification
  • Rise 'N Shine Early Learning Centre reserves the right to refuse access to ANYONE who does not appear to be in a responsible condition
The Following Named Are NOT Allowed Access to My Child
Name
Relationship To Child
Name
Relationship To Child
Child Care Information
Has your child been in childcare before?
Day Home, Daycare or in the care of Family?
If previous Daycare, name of centre
Estimated Arrival Time at our centre
Estimated Departure Time from our centre
Tell us about your child
Parental Consent and Confirmation

The following sections require parent signatures to make the registration valid. Reading the Parent Handbook and our Policies & Procedures Manual is also required.

If filling out the application on-line, your typed name will be accepted as your signature. Your signature is confirmation of your understanding and agreement of the information on the Registration Form, in the Parent Handbook and the Policies & Procedures Manual.

I/we give Kildare Childcare & OSC permission to take whatever steps are necessary to provide emergency medical treatment for my/our child as warranted. If an ambulance is required I/we understand that it will be at my/our expense.
Parent(s) Initials
I/we give Kildare Childcare & OSC permission to take photographs of my/our child in their daily activities and post them on display in the centre. Photos will not be used for advertising, publication or telecast without explicit permission for that specific event.
Parent(s) Initials
I/we give permission to Kildare Childcare & OSC to take my/our child off the centre's premises for neighbourhood walks, park outings and other such related activities while in the care of staff. For all other field trip outings, a permission form will be distributed and parent's signatures will be required for child participation.
Parent(s) Initials
I/we understand that Kildare Childcare & OSC aims to provide quality care for all children and families in a safe and comfortable environment. I/we understand that Kildare Childcare & OSC reserves the right to refuse or discontinue enrolment at their discretion should they feel my/our child poses a health or safety concern, displays unmanageable behaviour issues or is not suited for the program.
Parent(s) Initials
I/we confirm that I/we have read and agree to the terms as laid out in the Parent Handbook and Policies & Procedures Manual. Further I/we understand that these rules and regulations are subject to change and I/we will be notified of any changes within a reasonable time. I/we will confirm in writing to adhere to the changes in order for my/our child/ren to continue to participate in the program.
Parent(s) Initials
I/we confirm that I/we understand that a minimum of 30 days WRITTEN notice of withdrawal provided DIRECTLY to the owners/directors is required or I/we are required to pay the next months fees in full.
Parent(s) Initials
I/we understand that is my/our responsibility to keep my/our subsidy up-to-date. I/we further understand that if coverage is cancelled or suspended for any reason I/we are responsible for fees due in full.
Parent(s) Initials

Print Parent Name(s)

1
2

Parent Signature(s)

1
2
Date