Creō Kids Licensed Child Care Registration

Creō Kids Child Care Registration

PLEASE FILL OUT EACH SECTION TO THE BEST OF YOUR ABILITY
- FULL LEGAL NAME OF CHILD
  
  First NameMiddle NameLast Name
- NAME CHILD RESPONDS TO
- DATE OF BIRTH
  
  MonthDayYear
  Date
- GENDER
- 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
- 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
- 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
- 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
- PERSON #2
- NAME
  
  First NameLast Name
- RELATIONSHIP TO CHILDREN
- PHONE
  
  Area CodePhone Number
- CHECK ALL THAT APPLY
- PERSON(S) WHO ARE NOT PERMITTED TO ACCESS MY CHILDREN
  
  (If applicable)
- LIST THE NAME, PHONE NUMBER AND RELATIONSHIP TO CHILD
- IF YOU HAVE A CUSTODY OR LEGAL ORDER PLEASE ATTACH A COPY FOR THE FACILITY LICENSEE
  
  Browse Files
  
  Cancelof
- COMMENTS:
- EMERGENCY HEALTH INFORMATION
- CARE CARD NUMBER
- FAMILY DOCTOR/CLINIC NAME
  (LIST A WALK IN CLINIC IF YOU DON'T HAVE A FAMILY DOCTOR)
- DOCTOR/CLINIC PHONE
  
  Area CodePhone Number
- EMERGENCY CONSENT
- It is the policy of Creō Kids to notify a parent when a child is ill or needs medical attention. If medial attention is needed and we cannot contact parents and need to get immediate help for the child, our procedure is to take the child to the nearest medial service.
- BY INITIALLING BELOW, I, HEREBY AUTHORIZE THE STAFF AT CREŌ KIDS TO CALL A MEDICAL PRACTITIONER OR AMBULANCE / TRANSPORT CHILD TO EMERGENCY MEDICAL CARE, IN THE CASE OF ACCIDENT OR ILLNESS OF MY CHILD(REN), IF THE PARENT CANNOT IMMEDIATELY BE REACHED
  PARENT INITIALS
- Fraser Health Child Care Licensing requires we have a photo of each child in care incase of emergency. Please upload a clear current photo of your child's face with no one else in the photo. If you have issues uploading please email a photo to info@creokids.ca
  
  Browse Files
  UPLOAD JPEG or PDF Cancelof
- CHILD'S IMMUNIZATION STATUS
- IS YOUR CHILD UP TO DATE ON IMMUNIZATIONS?
- COMMENTS:
- HEALTH INFORMATION
- Does the child (SELECT ALL THAT APPLY IF APPLICABLE)
- REGULAR MEDICATIONS AND REASONS FOR (please list)
- ALLERGIES AND TREATMENT OF (please list)
- FOOD ALLERGIES?
- PLEASE DESCRIBE FOOD ALLERGIES & TEATMENT
- INJURY(S), ILLNESS(ES) OR OPERATIONS YOUR CHILD HAS HAD - INCLUDE DATE(S) (IF APPLICABLE)
- 1.) PLEASE DESCRIBE ANY CONCERN(S) / ISSUES REGARDING YOUR CHILDS HEALTH (e.g. seizures, asthma, vision, hearing, etc)
- 2.) PLEASE DESCRIBE ANY CONCERNS YOU MAY HAVE REGARDING YOUR CHILDS DEVELOPMENT (e.g. behaviour, vision, hearing, speech, language, mobility, etc.)
- 3.) DESCRIBE ANY SPECIFIC CARE INSTRUCTIONS REGARDING 1.) AND/OR 2.) ABOVE
- LIST ANY HEALTH CARE PROFESSIONALS INVOLVED IN YOUR CHILDS LIFE (e.g. occupational therapist / physical therapist)
- ADDITIONAL INFORMATION YOU MAY WANT US TO KNOW ABOUT (IF APPLICABLE)
- HAS YOUR CHILD HAD PREVIOUS GROUP CARE EXPERIENCES AND HOW DID THEY ADAPT?
- HOW DOES YOUR CHILD BEHAVE TOWARD OTHER CHILDREN? (e.g. seeks others out, feels shy):
- HOW DOES YOUR CHILD ADAPT WHEN LEFT WITH UNFAMILIAR PEOPLE AND/OR IN UNFAMILIAR SITUATIONS?:
- DOES YOUR CHILD HAVE ANY PARTICULAR FEARS? PLEASE DESCRIBE:
- WHAT SUGGESTIONS CAN YOU SHARE THAT WOULD HELP OUR STAFF MAKE YOUR CHILDS TRANSITION INTO THIS PROGRAM EASIER?
- ARE THERE ANY RELIGIOUS OR ETHNIC OBSERVANCES RELATED TO FOODS?:
- ANY OTHER INFORMATION WE SHOULD BE AWARE OF:
- 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.
- 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
- I have read and agree to the terms and conditions listed in The Parent Handbook
- NAME
  
  First NameLast Name
- DATE
  
  MonthDayYear
  Date
- EMAIL OF AUTHORIZED SIGNER
  example@example.com
- SIGNATURE OF PARENT OR GUARDIAN PROVIDING INFORMATION
- 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