The Kinder Garden - Application for Enrollment

The Kinder Garden Children's Centre

Application for Child Care & Preschool Enrollment
For Office Use ONLY- File Admission Date
For Office Use ONLY- File Discharge Date
For Office Use ONLY- Program Placement

InfantInfant in TodToddlerPreschoolJunior School
Is this a new application for enrollment or an update to an existing child's enrollment file?*

New ApplicationFile Update
Please choose your requested start date (must be on the 1st of any given month)*

DayMonthYear
Date
Please indicate your first choice of program days by selecting a field below (confirmation of availability will be sent by email)*

5 Day Program (Mon-Fri) Available for Infant, Toddler, Preschool3 Day Program (Mon/Wed/Fri) Available for children 13 months - 5 years (full day)2 Day Program (Tues/Thurs) Available for children 13 months - 5 years (full day)
In the event that your first choice of program days are unavailable please indicate your second choice of program days below (confirmation of availability will be sent by email)*

5 Day Program (Mon-Fri) Available for Infant, Toddler, Preschool3 Day Program (Mon/Wed/Fri) Available for children 13 months - 5 years (full day)2 Day Program (Tues/Thurs) Available for children 13 months - 5 years (full day)
CHILD INFORMATION:
Child's Name*

First NameLast Name
Gender*

MaleFemaleOther
Birth Date*

MonthDayYear
Child's Home Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Home Phone Number*

Area CodePhone Number
Who does the child live with?

Both ParentsFatherMotherGrandparent(s)Foster Parent(s)Other
Are there any access orders/agreements, court orders or custody documents regarding this child?

YesNoOther
Language(s) Spoken at Home*
Previous school/child care attended:
Sibling #1 Information

NameAgeSchool
Sibling #2 Information

NameAgeSchool
Sibling #3 Information

NameAgeSchool
PARENT/GUARDIAN INFORMATION:
Parent/Guardian #1 Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Home Phone Number*

Area CodePhone Number
Mobile Phone Number*

Area CodePhone Number
Email*
example@example.com
Occupation*
Name of Workplace*
Work Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Phone Number*

Area CodePhone Number
Work E-mail (if applicable)
Does parent/guardian #2 have the same address as parent/guardian #1?*

YesNoThere is no second parent/guardian
Parent/Guardian #2 Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Home Phone Number*

Area CodePhone Number
Mobile Phone Number*

Area CodePhone Number
Email*
example@example.com
Occupation*
Name of Workplace*
Work Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Phone Number*

Area CodePhone Number
Work E-mail (if applicable)
example@example.com
Alternate Emergency & Child Release Information

Please provide two alternate adults (other than parents/guardians listed above) that can be contacted in an emergency and that you permit your child to be released to if needed.
Emergency Alternate Adult #1*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Phone Number*

Area CodePhone Number
Work Phone Number*

Area CodePhone Number
The person listed above is permitted to pick my child up from The Kinder Garden.*

yesno
Emergency Alternate Adult #2*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Phone Number*

Area CodePhone Number
Work Phone Number*

Area CodePhone Number
The person listed above is permitted to pick my child up from The Kinder Garden.*

yesno
MEDICAL INFORMATION
Physician Name*

First NameLast Name
Physician Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Health Card Number*
Please list all allergies/medical concerns/special needs. (Please indicate "none" if none are present)*
(Please describe/if none, please indicate with "none")
Does this child require an Epi-pen?*

yesno
Does this child take medications on a regular basis?*

yesno
If yes, please provide details
Does this child have any physical limitations that we need to be aware of?*

yesno
If yes, please provide details
Are there any other social, emotional, physical or medical details that may be helpful for us to know? (Please indicate "none" if none are present)*
If there is no additional information please indicate n/a
Is your child currently enrolled in school?*

YesNo
If yes, please provide the name of your child's school and current grade level. If no, please enter N/A
Does your child currently have an IEP or an ISP?*

YesNo
What is your child's diagnosis?
Please upload a copy of your child's IEP or ISP

Browse Files

Cancelof
Please upload your child's most current immunization records or signed medical exemption certificate*

Browse Files

Cancelof
History of Communicable Diseases: Please indicate if this child has had any of the following:*

Chicken PoxWhooping CoughMumps (German Measles)RubellaMeaslesHepatitis BNone
Please indicate any additional information regarding skin disorders, sight and/or hearing difficulties. (Please indicate "none" if none are present)*
Please indicate any food restrictions (allergy/religious) or food sensitivities that we should be aware of. (Please indicate "none" if none are present)*
Please click here to submit your child's photo for their file and cubby bin*
I give The Kinder Garden Children's Centre permission to apply the following topical products to my child when required and for the duration of my child's placement at The Kinder Garden Children's Center. All products will be provided only by me for my child's use.*

SunscreenInsect RepellentLip BalmSkin LotionVaselineDiaper Rash OintmentTeething GelNoneOther
Parent/Caregiver Signature*
Service Contract and Policy Agreement

Please complete by signing on the line provided for each agreement. By signing each statement you are agreeing to the terms of our service.
I have read through The Kinder Garden's current Family Handbook and understand and agree to comply with all rules, policies and procedures stated within. (Please sign below)*
I understand that I am responsible for a "late pick up fee" of $20 per 15 minutes or part thereof in the event that I arrive or leave the building after the posted closing time. This payment is due upon arrival on my child's next day or attendance and is to be paid in cash to the educator who stayed late. (Please sign below)*
I understand that my child will not be released to anyone other than the people listed on my child's enrollment forms under Emergency Contacts who I have indicated that my child may be released to. It is my responsibility to inform staff when an emergency person will be picking my child up. My emergency people are required to present government issued identification to staff at the time of pick up. (Please sign below)*
I understand and agree that I am responsible for full payment of my child's scheduled days at The Kinder Garden Children's Centre and that I will be charged a fee of $60 for payments that are returned from my financial institution. I also understand that there is no fee exemption due to illness, weather, vacation, absence, emergency and holiday closures or termination of my child's service by The Kinder Garden as outlined in the Family Handbook. (Please sign below)*
I agree to give The Kinder Garden Children's Centre a minimum of 32 days notice of withdrawal in writing as required and outlined in the Family Handbook. Should I choose to withdrawal my child from the program, I understand that I will be responsible for my child care fees for the duration of my period of notice (32 days or greater) and that full payment will be required within 7 days of my providing notice. The remainder of my Notice of Withdrawal period will not commence until full payment has been received. (Please sign below)*
I have read through the illness/sick policy and have a clear understanding of what is expected. I understand that for Health and Safety reasons I cannot knowingly send my child to The Kinder Garden without disclosure of any known medical conditions, illness, fever and/or allergy information and doing so may result in my child's termination from their program. (Please sign below)*
I have read through the Behavior Management policy and have a full understanding of how staff at The Kinder Garden will deal with behavioral issues in the classroom. (Please sign below)*
Safe Arrival Policy: I have read through the safe arrival policy and have a clear understanding of what is expected. I understand that I am required to email The Kinder Garden no later than 930am to report my child's absence each day along with the reason for the absence. (Please sign below)*
Media Consent: Please select one or more to indicate your consent regarding how your child's art work and photos may be used by The Kinder Garden Children's Centre.*

I give permission to The Kinder Garden to photograph, audio record and/or video tape my child for the purpose of professional development within the organization.I give permission to The Kinder Garden to display my child's work including art, class photos and individual photos within the centre and in the classroom learning story binders.I give permission to The Kinder Garden to post photos of my child engaging with their educators and peers on the organizations website and/or social media account as a way to share how children learn with our local community.
Parent Consent Signature*
Community Walks: Often we like to include walks in and around our community as part of our program plan in order to continue and complement our teachings of the seasons, community helpers, our observations of nature and to provide variety during our daily outdoor time. Small children will be secured safely in a stroller while the older children will walk with an educator. Staff to child ratios will not be reduced during times that the children are outside in the playground or off premises as regulated by the Child Care and Early Years Act and The Ministry of Education. Parents will be notified through Daily Connect when educators plan to take children into the community .
I First Name* Last Name* give The Kinder Garden Children's Centre permission to take my child: First Name* Last Name* on walks within the community for educational and outdoor variety purposes. I understand that the children will always be walking with qualified staff members of The Kinder Garden. Date*
Parent Consent Signature*
Personal Information: I hereby consent to the collection, use and disclosure of my child's information by The Kinder Garden for the purposes of providing child care services to my child enrolled in centre programs. I understand that the centre protects the privacy of all personal information in its possession in compliance with prevailing privacy legislation. (Please sign below)*
Non-Refundable Deposit Agreement
I First Name* Last Name*understand and agree that my enrollment deposit in the amount of $285.00 ($250.00 + $75.00 registration fee) ($40 of the registration fee is currently covered by the province) is non-refundable should I choose to cancel my child’s enrollment at The Kinder Garden. I may only change my child’s start date without penalty (loss of deposit) if my amended date is approved by the Director and if there is a space available. Date*
Signature of Parent*
How did you hear about us!*

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The Kinder Garden Children's Centre

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION:

Alternate Emergency & Child Release Information

MEDICAL INFORMATION

Service Contract and Policy Agreement