Fill-up Form
"Complete our streamlined fill-up form to enroll your child with ease. Ensure every detail is covered for a seamless start to their educational journey with us."
First Parent
Relation to Child
*
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Address
*
Address
Street Address Line 2
City
State
Zip Code
Personal Email Address
*
example@example.com
Second Parent
Relation to Child
*
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Address
*
Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Personal Email Address
*
example@example.com
Child
Name
*
Given Name
Last Name
Goes By
Birthdate
*
-
Month
-
Day
Year
Required
Gender
*
Please Select
Male
Female
Will you require transportation to school?
Please Select
No
Not applicable
Yes
Child lives with
Mother
Father
Other
Is there a custody agreement?
No
Yes
Enrollment
*
-
Month
-
Day
Year
Desired Start Date
Frequency
*
Please Select
Full Time
Part Time
Drop In
Medical
Health Care No.
Physician's Name
Physician's Phone
Diet Restrictions
*
Allergies
*
Other Medical Concerns
*
Are your child's immunizations up to date?
*
No
Yes
Does your child require medication, or carry emergency medication?
*
No
Yes
Subsidy
*
Subsidy is approved
I have applied for subsidy
I will apply for subsidy
I need help applying for subsidy
I do not plan to apply for subsidy
~If Subsidy is approved
~If applying for subsidy
Other questions, comments, or notes
Emergency Contact
Other than parents
Relation to Child
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Authorized for Pickup
Yes
No
Agreements
Medical Authorization
In the event that I can not be reached and emergency medical treatment is required for my child, I hereby agree to allow the Director or staff of Kidzonia Childcare Centre to seek any medical treatment appropriate. I agree to be responsible for any costs incurred as a result of this medical treatment.
Vacation and Sick Days
I agree that fees are still applicable during absences and vacation periods.
Deposit and Registration Fees
I agree that I need to pay monthly fees every 1st of the month. Waivers/Consent forms are also required to be completed and signed. No refunds if decided to cancel.
Toys and Technology from home
Technology from home (iPads, iPods, Laptops, computers, smartwatches etc.) will not be brought into the program. Strongly discourage toys from home from being brought to the Centre unless they are essential to a child’s emotional well-being and/or sense of belonging
Sunscreen Application
I hereby authorize Kidzonia Childcare Centre staff to apply sunscreen (provided by parents) on my child in spring and summer as needed.
Himama
By signing this form you grant permission for us to photograph or video your child for the purposes of sharing this information with you through the Program. You will also receive updates and information about your child through the Program to the email you have provided herein. Note that sometimes other children in the centre may feature in photos, videos or stories of your child. By giving your consent you agree not to share photos or video of any child, other than your own, outside the Program without permission.
Evacuation
In the case of an emergency evacuation like fire, flood, gas leak, chemical spill or any natural disaster, I give permission for my child listed above to be relocated to another site as deemed necessary. I understand that transportation or walking may be required.
Illness
If centre staff notifies me that my child is ill, I will pick up my child as soon as possible and no later than one (1) hour after being contacted. If my child contracts a contagious illness, I understand that my child may return only when he or she is well, as described in the Parent Handbook.
Centre Hours
Centre is open Monday to Friday from 6:00am - 8:00pm ( Saturday for extended care ) The centre will be closed New Year’s Day, Alberta Family Day, Good Friday, Easter Monday, Victoria Day, Canada Day, Labour Day, Truth and Reconciliation Day, Thanksgiving Day, Remembrance Day, Christmas Day.
Assessments and Screenings
I give permission for my child to participate in early learning assessments and screenings administered by Kidzonia Childcare Centre. The results of these assessments will be used to measure my child’s progress and may be used to evaluate and update the centre's programs. I will have access to all results of these assessments.
Communication
I give Kidzonia Childcare Centre permission to communicate with me by telephone, text, e-mail, or other means. I understand Kidzonia Childcare Centre privacy policy applies to the information I provide.
Insect Repellent Application
I hereby authorize Kidzonia Childcare Centre staff to apply insect repellent (provided by parents) on my child in spring and summer as needed.
Photographic Release
I give permission for my child to be photographed and videoed in the centre and during program functions and field trips. I understand that photographs/videos may be taken by centre staff or by other parents/guardians, and I consent to the use of these photographs/videos for communication purposes, such as communication with families and internal business communications.
Photo for Online Media
I hereby consent to and authorize the centre to use and reproduce photographs taken of my child to use for display on our website and any online social media platform.
Field Trips & Neighbourhood Walks
I understand that field trips and walks to neighbourhood areas and parks are part of the programming at Kidzonia Childcare Centre and I hereby give consent for my child to participate in these activities.
Telephone Number Release
Other parents sometimes request a family's phone number so they can phone to invite your child to a birthday party or some other social event. Please check the box if you have no objections to the release of your phone number for this purpose.
Wrap up
Just a little survey for us.
How did you first hear about us?
*
Facebook
Instagram
Google
Alberta Government Website
Web Search
Word of Mouth (referral)
Drive by (saw the signages)
Other
Submit Registration
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