King's Kids Preschool Registration Form

King's Kids Preschool Registration Form
I would like to register my child for:
- Child's Name
  
  First NameMiddle NameLast Name
- Date of Birth
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Phone
  Please enter a valid phone number.Format: (000) 000-0000.
- Mailing & Physical Address (we do need BOTH the mailing and the physical addresses please)
  
  Mailing Address
  
  Street Address
  
  CityState / Province
  
  Postal / Zip Code
- Gender
- Alberta Health Care # blanks*.
- Does your child have any allergies we should be aware of?
- If yes, please provide details:
- Does your child require medication / epi-pen for the above mentioned allergies? * If yes, an Individual Record of Medication/Herbal Remedy Administration Form needs to be filled out (see church office staff for form). Epi-pens & inhalers MUST be left with your child's teacher each day your child is in attendance.
- Are your child's immunizations up to date?
- Are there any developmental delays, medical or behavioral situations we should be aware of?
- If yes, please explain:
- Parent/Guardian Name 1
  
  First NameLast Name
- Email
  example@example.com
- Relationship
  Mother, Father, etc
- Mobile Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Work Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Address
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Parent/Guardian Name 2
  
  First NameLast Name
- Email
  example@example.com
- Relationship
  Mother, Father, etc.
- Mobile Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Work Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Address
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Emergency Contact 1
  
  First NameLast NameRelationship
- Home or Work Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Mobile Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Emergency Contact 2
  
  First NameLast NameRelationship
- Home or Work Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Mobile Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Please list all person(s) authorized to pick up your child. Name, Phone # & Relationship to your child. ie. Susan Smith 555-123-4567 Aunt *Please note: a court order needs to be provided if a birth parent is NOT allowed to pick up your child.
- I give permission for my child blanks* to leave Sturgeon Alliance Church premises on walks or community outings. I give permission for First Aid to be administered to my child blank*in the event of an emergency, and that I will assume any cost involved in a medical emergency. However, I understand and agree to indemnify and hold blameless Sturgeon Alliance Church's Ministry Staff, Volunteers, its Pastors and the Board of Elders from and against any loss, damage or injury that may be suffered as a result of being part of the activity.
- I give permission for photographs or videos to be taken of my child by the church or any other organization for promotional purposes.
- I give permission for my child's first name to be used in any photos and or videos.
- I give permission to display any artwork or writing of my child in the church building.
- I understand that my child's personal information will not be shared outside the church, unless your consent is obtained.
- Registration is not complete until a $10 Registration Fee is paid. Payments can be made by e-transfer or cash. Please e-transfer preschool.payments@sturgeonalliance.org or bring cash payment to the church office (Mon-Thurs from 9am-3pm).
- Signature
- Should be Empty: