Preschool Registration Form

Enrollment Form
Registration*

Pre-SchoolSummer CampBoth
PARENT/GUARDIAN INFORMATION
Mother/Guardian Name*
Address*
Cell Number*
Home Number
Email
example@example.com
Occupation*
Office Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

PARENT/GUARDIAN INFORMATION
Father/Guardian Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Number*
Home Number
Email
example@example.com
Occupation*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Office Number

EMERGENCY CONTACT (Other Than Parents/Guardian)
Full Name*
Relationship to child*
Contact *
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

STUDENT INFORMATION
Child's Full Name*
Student's Gender*

MaleFemale
Date Of Birth (Day/Month/Year)*
Religion
MEDICAL INFORMATION
Family Doctor

First NameLast Name
Contact Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

City

Postal / Zip Code
Allergies (state symptoms and instructions)
SPECIAL REQUIREMENTS
Diet
Medication
Previous illness or injuries

PICK UP INFORMATION

Please list the names and numbers for persons authorized to pick up your child. (PERSONS WOULD BE REQUIRED TO PRODUCE A VALID FORM OF I.D)

	NAME	RELATIONSHIP	CONTACT #	VEHICLE NUMBER PLATE
FULL NAME
FULL NAME
FULL NAME
FULL NAME

Please click yes if you WILL give permission to have photographs of your child taken*

YesNo
How did you find us?

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COPIES OF DOCUMENTS REQUIRED
CHILD

IMMUNIZATION CARD

BIRTH CERTIFICATE

TWO PASSPORT PHOTOS

PARENTS

VALID FORM OF I.D

PUBLIC UTILITY BILL
Signature

Clear
Should be Empty: