CNC Childminding Program Drop-In Form

CNC Childminding Program for Language Training

Drop-in Registration Form
Child's Name *

First Name Last Name
Name Used *
Date of Birth *

Month Day Year
Gender *

Male Female
Languages Spoken *
Parent's Name *

First Name Last Name
Phone Number *
Please enter a valid phone number.
Address *

Street Address

Street Address Line 2

City State / Province
Child's medical information (allergies, food restrictions, other) *
WAIVER STATEMENT

I,  First Name*Last Name* am the parent of   Child's Name*.
I have provided all the information and knowledge needed to care for my child. I understand that CNC Childminding program will take all reasonable safety measures to protect this child. I agree tp release, absolve, discharge, and hold harmless VCCM, its employees and volunteers from any and all claims to the fullest extent allowed by law including, but not limited to, claims or damages arising out of the child's participation in this program

I know that care is only provided while I am participating in an approved program and that I must remain on site and readily available. I understand that care will not be provided if my child has a communicable illness. I agree to follow the rules of the CNC program.

Signature of eligible parent*   Date*
This Childminding program is not licensed by the Government of Ontario

For ISO use only:
Date information provided

Month Day Year
Date
Date information updated

Month Day Year
Date
Should be Empty:

CNC Childminding Program for Language Training