CELC Enrollment Form

Enrollment Form

Colchester Early Learning Centre
Child
Full Name*

First NameMiddle NameLast Name
Age*
Date of Birth*

MonthDayYear
Date
Home Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Parent/Guardian
Full Name*

First NameLast Name
Home Phone
Cell Phone
Work Phone
Email*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Parent/Guardian #2
Full Name

First NameLast Name
Home Phone
Cell Phone
Work Phone
Email
example@example.com
Home Address

Street Address

Street Address Line 2

CityProvince

Postal Code
Emergency Contact
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Names of people authorized to pick your child up from the program*
*Please include first and last name & phone number
Colchester Early Learning Centre welcomes all children of all abilities and strives to offer the support needed to help your child succeed. This may include any support identified by other professionals ex: Hearing and Speech, Early intervention, EIBI, Occupational Therapy, etc. Please Identify any additional supports your child may require for meaningful and successful participation in our program.*
*This may also include if your child has experienced trauma in the past.
Colchester Early Learning Centre welcomes all children of all abilities and strives to offer the support needed to help your child succeed. This may include any support identified by other professionals ex: Hearing and Speech, Early intervention, EIBI, Occupational Therapy, etc.
Should be Empty:

Enrollment Form

Child

Parent/Guardian

Parent/Guardian #2

Emergency Contact