Woodland Wonders- School/Transportation Information Form

The Kinder Garden Children's Centre

Before and After School Transportation and Information Form
Child's Name *
Child's Date of Birth *

Month Day Year
Date
Home Address *
Emergency Contact (Parent) Name *
Emergency Contact (Parent) Number *
Emergency Contact (Secondary) Name: *
Emergency Contact (Secondary)Number *
Emergency Contact (Secondary): Relation to Child *
Allergy Information: (Please List Allergens and Reactions) *
Does your child have an anaphylactic allergy? *
If yes, we will contact you to request more information. Two EpiPen's are required to be provided to our program if your child has a known anaphylactic reaction and an anaphylaxis plan will need to be created before your child starts our program.
Any special needs/safety concerns *
What program did you sign your child up for? *

AM Care Only PM Care Only Both AM and PM Care
Child's School *
School Address *
Child's Grade *
Child's Current Teacher *
For children attending Borden schools, please indicate the arrival times for both the morning bus and afternoon bus so that we can ensure that a staff member will be waiting at the front for your child's arrival.
My child's bus will arrive at The Kinder Garden at Time AM each day to pick my child up for school.
My child's bus will arrive at The Kinder Garden at Time PM each day to drop my child off for the after school program.
Child's first day of school *
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For children attending a school located in Angus, has the school been notified that our program will be picking up your child?

Yes No
Child's Current Weight: (in lbs only please) *
If a child is under 40lbs, they are required to be in a 5 point harness car seat. All 5 point harness car seats are to be provided by the parent along with a copy of the original purchase receipt indicating date of purchase. Booster seats will be provided to children over 40lbs by our facility.
Car Seat Brand and Color:
Date of Purchase:
Proof of Purchase: (Mandatory) Please attach a copy of your receipt or other proof of purchase.

Cancel of
I certify that the car seat that I am providing for my child to use in the child care facility's van was purchased brand new. I also certify that the car seat that I am providing has never been involved in a motor vehicle accident.
Print Name
Parent Signature

Clear
Date

Month Day Year
Date
I give permission to The Kinder Garden Children's Centre to transport my child to and from the local schools for the purpose of providing transportation as part of the Before and After School Program.
Print Name
Parent Signature

Clear
Date

Month Day Year
Date
I have read and will follow all policies and procedures with respect to The Kinder Garden's Before and After School program and will ensure that my child will adhere to the centre's code of conduct outlined in the Family Handbook.
Print Name *
Parent Signature *

Clear
Date *

Month Day Year
Date
Should be Empty:

The Kinder Garden Children's Centre