Creō Kids Licensed Child Care Registration

Creō Kids Child Care Registration

PLEASE FILL OUT EACH SECTION TO THE BEST OF YOUR ABILITY

CHILD INFORMATION
FULL LEGAL NAME OF CHILD*

First NameMiddle NameLast Name
NAME CHILD RESPONDS TO*
DATE OF BIRTH*

MonthDayYear
Date
GENDER*

MF
SCHOOL ATTENDED*
GRADE YOUR CHILD WILL BE IN AT START OF CARE*
PRIMARY ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PRIMARY PHONE

Area CodePhone Number
PRIMARY CONTACT EMAIL
example@example.com
CHILD'S FIRST LANGUAGE*
CHILD'S SECOND LANGUAGE
PERSON(S) WITH WHO CHILD LIVES*
For example: Both parents, mom or dad

PARENT / GUARDIAN INFORMATION #1
NAME*

First NameLast Name
ADDRESS (If different from primary address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
HOME PHONE

Area CodePhone Number
CELL PHONE*

Area CodePhone Number
WORK/OTHER PHONE

Area CodePhone Number
EMAIL*
example@example.com

PARENT / GUARDIAN #2 IF APPLICABLE
NAME

First NameLast Name
ADDRESS (If different from primary address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
HOME PHONE

Area CodePhone Number
CELL PHONE

Area CodePhone Number
WORK/OTHER PHONE

Area CodePhone Number
EMAIL
example@example.com

AUTHORIZED PERSON(S) / EMERGENCY CONTACT
ALTERNATE PERSON(S) AUTHORIZED TO PICK UP CHILDREN OTHER THAN PARENT/GUARDIAN

(Other than parent/guardian, include emergency pickup, can be a friend or family member)
PERSON #1
NAME*

First NameLast Name
RELATIONSHIP TO CHILD*
PHONE*

Area CodePhone Number
CHECK ALL THAT APPLY*

AUTHORIZED TO PICKUP CHILDRENAUTHORIZED TO CALL IN AN EMERGENCY
PERSON #2
NAME*

First NameLast Name
RELATIONSHIP TO CHILDREN*
PHONE*

Area CodePhone Number
CHECK ALL THAT APPLY*

AUTHORIZED TO PICKUP CHILDRENAUTHORIZED TO CALL IN AN EMERGENCY
PERSON(S) WHO ARE NOT PERMITTED TO ACCESS MY CHILDREN

(If applicable)
LIST THE NAME, PHONE NUMBER AND RELATIONSHIP TO CHILD

PARENTAL CONSENT/TERMS & CONDITIONS
PLEASE NOTE: THIS INFORMATION MAY BE REVIEWED BY FRASER HEALTH AUTHORITY LICENSING STAFF AS PER LEGISLATION
Parental Consent & Terms/Conditions

Offsite Playground, Walking Field Trips & Photo Release
I, hereby give my full consent and approval for my child to participate in activities at the Creō Kids off site playground located across the street at White Rock Elementary and walking field trips around White Rock and to White Rock Beach. I understand that there are certain risks of damages and injuries inherent in the participation of my child in these activities and I hereby accept these risks on behalf of my child. I hereby certify that my child is fully capable of participating in playground activities and walking field trips and that my child is healthy and has no physical or mental disabilities or infirmities that would restrict his/her full participation in such activities. I understand that it is my child's responsibility to abide by the rules and regulations imposed on the children by the supervisor and/or the supervisor's aide for the safe conduct of activities on the playground & walking field trips. I AGREE AND HEREBY, FOR MYSELF AND ON BEHALF OF MY CHILD, AGREE TO SAVE AND HOLD HARMLESS AND FULLY INDEMNIFY CREŌ KIDS MANAGEMENT AND STAFF AND ANY ALL LIABILITY FOR ANY PERSONAL INJURY OR INJURY TO ANY THIRD PARTY CHILD RESULTING FROM MY CHILD’S PARTICIPATION IN THE ABOVE MENTIONED ACTIVITIES. I HEREBY RELEASE 0777996 BC LTD DBA CREŌ KIDS AND ITS ENTIRE STAFF FROM ANY AND ALL LIABILITY FOR ANY INJURIES THAT MY CHILD MAY SUSTAIN AS A RESULT OF ANY ACTIVITIES THAT TAKE PLACE AT THE CREŌ KIDS OFF SITE PLAYGROUND AND ON WALKING FIELD TRIPS DURING DESIGNATED CARE HOURS.*

I have read and agree to the above terms and conditions
Creō Art Studio & Creō Kids reserves the right to use photographic material for advertising and promotional purposes. If you do not want your child(ren) photographed, please let us know*

YES, I agreeNO, I do not want my child photographed
I have read and agree to the terms and conditions listed in The Parent Handbook

SIGN & DATE TO COMPLETE
NAME*

First NameLast Name
DATE*

MonthDayYear
Date
EMAIL OF AUTHORIZED SIGNER*
example@example.com
SIGNATURE OF PARENT OR GUARDIAN PROVIDING INFORMATION*

Clear
Should be Empty:

Creō Kids Child Care Registration

ALTERNATE PERSON(S) AUTHORIZED TO PICK UP CHILDREN OTHER THAN PARENT/GUARDIAN

PERSON(S) WHO ARE NOT PERMITTED TO ACCESS MY CHILDREN

EMERGENCY HEALTH INFORMATION

CHILD'S IMMUNIZATION STATUS

HEALTH INFORMATION

INJURY(S), ILLNESS(ES) OR OPERATIONS YOUR CHILD HAS HAD - INCLUDE DATE(S) (IF APPLICABLE)

ADDITIONAL INFORMATION YOU MAY WANT US TO KNOW ABOUT (IF APPLICABLE)

Parental Consent & Terms/Conditions