Registration Form 2021-2022

Registration Form 2022-2023

BEDROCK PLAYSCHOOL
Student's Name *

First Name Last Name
Address of the Student *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Student's Age and Date of Birth *
Allergies or Food Restrictions *
Special Medical, Physical or Emotional Needs *
Parent 1 Name   First Name*   Last Name*   Area Code*   Phone Number*      Email*
Parent 2 Name   First Name*   Last Name*   Area Code*  Phone Number*
Email*
Emergency Contact Name & Phone Number *
Medical Information - does your child require any medications while at school? If so, we will require an additional form to administer
Are your child's immunizations up to date *

yes no
Guardianship, Custody or Access rights - Does such an order exist? *
LEAVE CONSENT: I hereby give my consent for my child to leave the classroom on outings under the supervision of the Playschool staff, within an one block radius of the Knox United Church *
PHOTO CONSENT: I allow for photos of my child to be taken and used for Playschool purposes such as yearend albums and bulletin boards *
PRIVACY POLICY - The information you supply in this registration form will be made available to the teachers and all of the board members. We also publish a class list and phone list of the families within the playschool so that you can exchange helper days, etc.
Please check here if you DO NOT want your NAME/PHONE NUMBER published on the class phone list.

Do NOT publish my phone number on any list
Policy Agreement - have you read, understand and agree to abide by all of the Bedrock Playschool policies, instructions and regulations as written in the handbook available on the website: www.bedrockplayschool.com *

yes no
FIRST AID- I give permission for the staff of Bedrock Playschool to administer first aid to my child named above, when necessary. *

YES NO

Rank your choice of class (we will be filling classes on a first come first serve basis) *

	First choice	Second choice	Third choice	Not intersted
4 year old MW am
4 year old MW pm
4 year old Thurs pm only
3 year old Tu/Th am
3 year old Tues pm only
3 year old Tues am only

Bedrock Playschool Child Abuse Pledge
I,   First Name*   Last Name*   understand and agree that as an employee, volunteer, or student at Bedrock Playschool, the children entrusted to our care are our central focus and as such will be treated with respect and dignity; abuse of any kind to a child is intolerable and cannot be condoned.

I understand that child abuse is defined in the Child Abuse Policy of the Association, as sexual, physical, psychological, or emotional abuse, molestation or harassment, including corporal punishment.

I agree that I will not subject the children to abuse of any kind. Furthermore, I agree that should I witness or become aware of child abuse that it is my responsibility to report this incident to my immediate supervisor, the teacher, or board member.

I understand that should I abuse a child, or fail to report child abuse that this action may result in my dismissal from my position with Bedrock Playschool.

Dated at Drumheller   Date*
Signature*
Should be Empty:

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Registration Form 2022-2023

Bedrock Playschool Child Abuse Pledge