Enroll Your Child

1

Child Information

General information about your child.

1

Child Identity

Basic identifying information.

First Name *

Last Name *

Date of Birth *

2

Home and Family

Address, language, and family details.

Home Address *

Language(s) Spoken at Home

Siblings Enrolled in the Centre *

Yes No

Sibling Name(s) *

2

Parent 1 Information

Primary parent or guardian details.

First Name *

Last Name *

Preferred Name

Relationship to Child *

Primary Phone Number *

Alternate Phone Number / Work

Email Address *

Same as child address

Home Address

Employer Information

Parents Relationship Status

Single Married Divorced

3

Parent 2 Information

Complete this section when applicable.

First Name

Last Name

Preferred Name

Relationship to Child

Primary Phone Number

Alternate Phone Number / Work

Email Address

Same as child address

Home Address

Employer Information

4

Custody Arrangements

Legal access and pickup restrictions.

Any custody arrangements pertaining to legal right of access? *

Yes No

Will appropriate legal documentation be provided? *

Name(s) of Custodial Parent(s) *

Individuals NOT Authorized to Pick Up Your Child *

5

Emergency Contacts

Emergency contact 1 is required. Contacts 2 and 3 are optional.

Emergency Contact 1 *

First Name *

Last Name *

Preferred Name

Relationship to Child *

Primary Phone Number *

Alternate Phone Number / Work

Home Address

Authorized to Pick Up Child?

Yes No

Emergency Contact 2

First Name

Last Name

Preferred Name

Relationship to Child

Primary Phone Number

Alternate Phone Number / Work

Home Address

Authorized to Pick Up Child?

Yes No

Emergency Contact 3

First Name

Last Name

Preferred Name

Relationship to Child

Primary Phone Number

Alternate Phone Number / Work

Home Address

Authorized to Pick Up Child?

Yes No

6

Additional Pickup Authorization

Photo ID will be required before the child is released.

First and Last Name

Relationship to Child

Primary Phone Number

First and Last Name

Relationship to Child

Primary Phone Number

First and Last Name

Relationship to Child

Primary Phone Number

7

Health and Medical Information

Family doctor, health history, allergies, restrictions, EpiPen, and immunization.

8

Physical Requirements and Additional Information

Daily routines, support, and accommodation needs.

Does Your Child Use Diapers?

Yes No

If No, Your Child:

Additional Physical Support or Accommodation Required?

Yes No

Physical Support or Accommodation Details *

Additional Information Relevant to Your Child's Care

9

Appendix A: Children Under 12 Months

This section appears when the child's age is under 12 months.

Children up to their first birthday will be placed on their backs for sleep unless a physician recommends differently in writing.

My Child Drinks *

Started Solid Foods? *

Yes No

Food Preparation / Texture

Pureed Formula Steamed Until Soft Other

Other Food Type

Can Self-Feed? *

Other Feeding Instructions

Number of Naps per Day *

Typical Nap Times *

Typical Nap Length *

Special Sleep Requirements? *

Yes No

Special Sleep Requirement Details *

This section is not required because the child's age is 12 months or older.

10

Appendix B: Non-Prescription Skin Products

Authorize products that may be applied according to the manufacturer's instructions.

1

Authorized Products

Select every product type that may be applied to your child.

Products That May Be Applied

Sunscreen Diaper Creams / Ointment Lip Balm Hand Sanitizers Insect Repellent Lotions

2

Product Details

Please include the brand name, product type, and expiry date.

Product 1

Product Name

Product Type

Expiry Date

Product 2

Product Name

Product Type

Expiry Date

Product 3

Product Name

Product Type

Expiry Date

11

Appendix C: Reportable Diseases

Select any reportable diseases your child has previously had or been diagnosed with.

12

Parent / Guardian Declaration

Please review and electronically sign the enrollment form.

I/we confirm that the information provided on this enrollment form is true, complete, and accurate to the best of my/our knowledge. I/we understand that it is my/our responsibility to notify Kinder Grove Infant and Child Care Centre promptly of any changes to emergency contacts, medical information, custody arrangements, or authorized pickup individuals.

I/we acknowledge that I/we have read, understood, and agree to comply with the centre's policies and procedures, including those outlined in the Parent Handbook. By signing below, I/we give permission for my/our child to participate in the daily routines and activities offered by the centre.

Parent / Guardian Full Name *

Date *

Parent / Guardian Signature *

Use your mouse, finger, or stylus to sign above.

Electronic Enrollment Form

Submitting Your Enrollment

Child Information

Child Identity

Home and Family

Parent 1 Information

Parent 2 Information

Custody Arrangements

Emergency Contacts

Emergency Contact 1 *

Emergency Contact 2

Emergency Contact 3

Additional Pickup Authorization

Health and Medical Information

Physical Requirements and Additional Information

Appendix A: Children Under 12 Months

Appendix B: Non-Prescription Skin Products

Authorized Products

Product Details

Product 1

Product 2

Product 3

Appendix C: Reportable Diseases

Reportable Disease History

Parent / Guardian Declaration

Ready to See Our Centre?