My Little Gan Enrolment Form

My Little Gan Enrollment Form

Part A: Child Information
Child's Name:*
First and Last Name
Hebrew Name:*
First and Last Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Birth*

MonthDayYear
Gender*

MaleFemale
Requested Start Date *
Previous School
Comments:

Part B: Medical Information
Physician Name*
Physician Number*
OHIP Number*
Allergies or Medical Conditions:
Medical Notes:
Health History:
Has there ever been a history of previous communicable diseases or conditions requiring medical attention? If yes, please explain in detail: *
Special Diet or Medication Required:
Rest Times:
Thank you for sharing your insights with us. It will help us to know your child better. Throughout the year, please be sure to update us on the results of observations from home –so we may better adjust the curriculum and focus.

Part C: Parents Information - Father
Title
Name:*
First and Last Name
Occupation *
Home Phone Number:*
Mobile Number:*
Work Phone Number:*
Email Address:*

Part C: Parents Information - Mother
Title
Name:*
First and Last Name
Occupation *
Home Phone Number:*
Mobile Number*

Area CodePhone Number
Work Number*

Area CodePhone Number
E-mail*

Part D: General Information
Marriage Status:*
Synagogue Affiliation:*
Have there been any adoptions/conversions? If yes, please explain:*
Emergency Contact Name #1:*

First NameLast Name
Emergency Contact Number #1:*

Area CodePhone Number
Emergency Contact #1 Email:*
example@example.com
Relationship to child:*
Emergency Contact Name #2:*

First NameLast Name
Emergency Contact Number #2:*

Area CodePhone Number
Emergency Contact #2 Email:*
example@example.com
Relationship to child:*

Authorizations for Pickup:
Authorized pick up #1 Name*

First NameLast Name
Phone Number

Area CodePhone Number
#2 Name*

First NameLast Name
Phone Number

Area CodePhone Number
#3Name*

First NameLast Name
Phone Number

Area CodePhone Number
Immunization Record*

I submitted a copy of my child's immunization recordI will submit a copy of my child's immunization record

Parent Assessment :
In order to provide you and your child with the best experience possible, and to ensure that we meet his/her developmental needs and goals, please complete the following questionnaire and return with forms. This information is confidential, and will be used by the classroom teacher to enhance the curriculum planning and sensitivity to each individual child. Assessing your child’s development during the year is an on-going process, and we encourage your feedback and involvement. Please answer as many questions as you feel comfortable answering.
What sparks your child's Interest?
Please share the cultural background/history of your family and primary and secondary languages.
What are your child’s special abilities and talents?
What kinds of activities engage your child’s focused attention?
Does your child have any special need of which we should be aware in the classroom setting?
Is there anything in your child’s or family’s life that might affect his/her adjustment to school?
What behaviours are you finding challenging to deal with right now and how do you deal with these?
Please assess your child’s developmental progress based on your own perceptions in the following areas:
Social Skills
Emotional Skills
Language Development
Visual Discrimination Skills
Gross Motor Skills
Fine Motor Skills
Physical Development
As a parent, what are your expectations of your child’s growth and development while in our program?
What goals would you like us to work toward together this year?
What specifically do you enjoy and appreciate about our program, that you would like us to continue and expand?
Are you interested in serving as a parent resource to our curriculum? Do you have special talents, skills, or cultural knowledge that you would like to share with our program?

Enrollment Options - Tuition/Fees:
Infant Program
Toddler Program
Preschool Program
Tuition*

I will provide 12 postdated chequesI will etransfer tuition on the first of every monthI will provide my credit card to be charged monthly (3.5% processing fee applies)
Date of Admission *
Date of Discharge
Should be Empty:

My Little Gan Enrollment Form