Little Bee Academy Registration Form

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Health #2: Does your child have any disability, disease, medical condition or other issue(s) including a diagnosis or features consistent with attention deficit hyperactivity disorder that you feel we should know about?

YesNo
If yes, please explain your child's condition:
Health #3: Is your child taking any ongoing medication?

YesNo
If yes, please explain your child's ongoing medication:
Health #4: Are your child's immunizations up to date?

YesNo
Please use an individual NOT listed as a parent or guardian
Emergency Contact #1 Name (first, last):
First, Last name
Emergency Contact #1 Phone:
Format: (000) 000-0000.
#1 Relationship to your child:
Emergency Contact #1 Email:
example@example.com
Emergency Contact #1 Address (inc. city, province, postal code):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact #2 Name (first, last):
First, Last
Emergency Contact #2 Phone:
Format: (000) 000-0000.
#2 Relationship to your child:
Emergency Contact #2 Email:
example@example.com
Emergency Contact #2 Address (inc. city, province, postal code):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
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Getting to know you
Child's Name (first, last):
First, Last
What foods does your child love?
What foods does your child dislike?
Any special dietary restrictions?
Favourite toys games or activities?
Is your child toilet trained?

YesNo
If yes, what words do they use to communicate they need to use the toilet?
How does your child express anger or frustration?
Is your child especially afraid of anything specific? Please explain
When your child is upset, what helps to comfort him or her?
Does your child usually take afternoon naps? If so, for how long?
Specific blanket or sleep aid for nap time?
Any special family situation that we can support of help with?
Anticipates adjustment problems?
Any development delays diagnosed or suspected?
Has your child been known to bite? If so, we will create a plan together to prevent anyone from getting hurt and to successfully redirect the biting.
If you are comfortable, please share your families spirituality so that we can learn about it and support that area of development here at the centre with your child.
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Registration Form