Clone of General Inquiry Contact Form

Child's Information
Full Name*

First NameLast Name
Date of Birth*

DayMonthYear
Sex*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Allergies/Ongoing Medications*

YesNo
Additional Information
Are Immunications up-to-date? *

YesNo
Alberta health Care #:*
Phone Number*
Please enter a valid phone number.
Email Address
example@example.com

Mother's Information
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone*
Please enter a valid phone number.
Work Phone*
Please enter a valid phone number.
Cell*
Please enter a valid phone number.
Email*
example@example.com
Place of Employment*

Father's Information
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone*
Please enter a valid phone number.
Work Phone*
Please enter a valid phone number.
Cell*
Please enter a valid phone number.
Email*
example@example.com
Place of Employment*

Custody Agreement
Instructions or arrangements
Doctor Name*
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contacts

Other than parents
Full Name*

First NameLast Name
Home Phone*
Please enter a valid phone number.
Work Phone*
Please enter a valid phone number.
Cell*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Place of Employment*
Relationship*

Release Policy

Your child will be released ONLY to those on the release form within this application. Your child won't be released otherwise without written permission from parents. If the person (including parents) is not recognised by the closing staff then we will request ID. It is very important that this form is filled out completely as well as updated periodically.
Child's Name: {fullName15} can be released to the following people:

First Name   Last Name
First Name   Last Name
First Name   Last Name
First Name   Last Name
First Aid Permission Policy:
I, Signature , give my consent for a qualified first aid staff member to use any first aid measures deemed necessary.
Picture Taking and Use of Name Policy:
I, Signature , give my consent for the use of my child's pictures and Name within the Centre. This could include bulletin boards, personal belongings, allergy lists, medication forms, and newsletters.
Bug Spray and Sunscreen Policy:
I, Signature , give my consent to the staff of Daycare Centre to apply bug spray and/or sunscreen when they go out for walks, and for outings outside of the Centre.
Daily Outing Policy:
I, Signature , give my consent for my child to go on daily walks around the neighborhood, and trips to Community Park. Children will be transported to the Park by the daycare van. The children will be accompanied by an appropriate number of teachers meeting licensing standards at all times.

All About Me

This information is used to for programming purposes only!
Child's Name: {fullName15}
Cultural Background
Please List Your Child's Favorite:
Breakfast food
Lunch food
Snack food
Songs
Books
Videos
Toy or Stuffed Animals
Cartoon characters
Games
Inside Activity
Outside Activity
If my child has trouble falling asleep I usually:
My child is afraid of:
Other people who have regular contact with my child (grandparents, step parents, siblings, friends, etc)

First Name   Last Name   Relationship:
First Name   Last Name   Relationship:
First Name   Last Name   Relationship:
First Name   Last Name   Relationship:
Anything else you would like to share about your child to help him/her feel more comfortable. Especially in the first week of care:

TERMS & CONDITIONS
We wish to extend a warm welcome to you and your family. We are happy to offer you a service where the happiness, safety, and welfare of your child are our major concerns.

1. The daycare closes at 5:45 p.m. Parents picking up their children after 5:45 p.m. will be charged $10.00 for every 15 minutes or portion thereof. Our employees work hard all day to provide special care for your children. They too are anxious to get back home to their families after work. Please pick up your child 15 minutes before closing.

2. Monthly fees are payable on the first day of each month. Fees paid after the fifth day of the month will be charged a late fee of $25.00 commencing on the 6th day of the month; if fees remain unpaid, a further late fee penalty of $25.00 on the 15th day of the month and a further $50.00 on the 30th day of the month, unless prior arrangements are made with management. There is a $50.00 charge for NSF cheques.

3. There will be a $50.00 registration charge payable at the time of registration; this is a non-refundable fee.

4. No refunds will be made for statutory holidays, sick days, or absent time, or for any other reasons.

5. Please inform the director (in writing) of any address changes, phone number or employer immediately.

6. Please keep your receipts intact, as we are unable to issue duplicates.

7. The child must be left with a staff member in the morning, not at the door. When picking up your child in the evening, please be sure to inform the staff member that the child is leaving. Please remember that it is the parents’ responsibility to sign the child “in” and “out.”

8. No medication will be administered to any child unless there is a doctor’s prescription for the particular child to whom the medication is intended. All medication must be given to a staff member by the parent. Be sure to fill out the medication form posted on the bulletin board.

9. Please inform us of any allergies that your child may have. We do not allow peanuts/tree nuts in the center due to children’s allergies.

10. Children should not be brought into the center if they are sick. If a child gets sick while under the care of the center, we will phone the parent asking them to take the child from the center for medical attention.

11. If your child is going to be absent from the center, please inform the Director/Assistant Director of the daycare center.

12. We will use all due care in caring for all children and their effects left with us; however, the daycare center will not be responsible or liable for any loss of, or for any accident, injury, sickness, or disease that may occur to any child while in the care of the daycare center.

13. The daycare center reserves the right to remove from its enrollment any child who is persistent in handicapping the progress of the group.

14. This acknowledges the receipt of the “Parent Handbook.”

In case of emergency, the daycare reserves the right to obtain appropriate medical aid from medical professionals; the parent authorizes the medical professional attending the child to obtain pertinent information from the child’s family physician, if deemed necessary.

Any articles the child brings must be labeled. The daycare center cannot be held responsible for any lost articles.

Children must have a complete change of clothes at the daycare, including a pair of “inside” shoes with rubber soles and a personal water bottle.

We will release your child only to the people authorized by you personally. If you have made special arrangements on a given day, please notify the daycare Director/Assistant Director. The daycare cannot be responsible for refusing any parent access to their child in case of parental separation or dispute.

I understand the above policies clearly and that they will be enforced. In particular:
- Payment of fees procedures; postdated cheques with registration
- One month written notice is required upon withdrawal of child from the daycare
- Late pick-ups
- Having alternative pick-up arrangements in case of accident, storm, etc.
Print Name*

First NameLast Name
Relationship*
Parent Signature*

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Date*

DayMonthYear
Date
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Child's Information

Mother's Information

Father's Information

Custody Agreement

Emergency Contacts

Release Policy

First Aid Permission Policy:

Picture Taking and Use of Name Policy:

Bug Spray and Sunscreen Policy:

Daily Outing Policy:

All About Me

Please List Your Child's Favorite:

TERMS & CONDITIONS