Address: 3 Elm Cres. S
Lethbridge AB
T1K 4W8
Phone: (403) 329-4944
Email:
Website:
REGISTRATION FORM
Sections with stars * must be filled out before your child may attend the daycare.
Please note Post Office box numbers are not addresses; we need coordinates or the rural address.
Commencement Date: ______
1. *Identifying Information*
Child’s Full Name: ______
Address: ______
Postal Code: ______
Date of Birth: ______
Alberta Health Care Number: ______
Parent/GuardianParent/Guardian
Name: ______Name: ______
Address ______Address ______
______
Home Phone: ______Home Phone: ______
Cell Phone ______Cell Phone:______
E-mail:______E-Mail:______
Business Phone:______Business Phone: ______
2. * Attendance *
Will your child be attending Full Time (Over 100 Hours/Month) or Part Time (Under 100 Hours/Month)
______
How did you hear about us? ______
______
If you were referred, who referred you?
GOVERNMENT SUBSIDY: check appropriate box
Subsidy is approved in the amount of $______monthly
I have applied for subsidy
I will be applying for subsidy
I do not plan to apply for subsidy
3. * Emergency Contact Information (Essential Information) *
Alternate Person(s) to contact in case of an emergency: Again no box numbers. Addresses are necessary.
1.) Name: ______
Address: ______
Phone Number (Home):______
Phone Number (Business):______
Phone Number (Cell):______
Relation to Child: ______
2.) Name: ______
Address: ______
Phone Number (Home):______
Phone Number (Business):______
Phone Number (Cell):______
Relation to Child: ______
**Authorized Person(s) to whom your child can be released:______
______
4. * Medical Data *
Is your child’s immunization up to date? Yes______No______
Physician’s Name: ______
Physician’s Phone Number: ______
- If your child has any of the following list accordingly:
Environmental Allergies: ______
Food Allergies: ______
Medications: ______
Describe what happens when they experience a reaction:
______
- Recurring medical problems (egg bronchitis, chronic ear infections, rash, asthma etc.)
______
- Seizures (yes/no):_____
- Does your child receive any prescribed daily medications?
Yes: ___ No: ___
- If so, name of medication/dosage/times: ______
5. *Family Information*
Single Parents
Does your child have contact with his/her other parent? Yes____ No ______
Will the other parent be likely to visit the day care? ______
Does the other parent have permission to take the child from the center? Yes_____ No ______
In the case of a court order restricting parental access a copy of the order must be supplied to the Daycare.
- Names and Ages of Siblings
1.______
2.______
3.______
4.______
6. General Information
Has your child previously attended a day care or day home?
Yes______No______
If so, when did they last attend: ______
- Comment on any important information we should know about:
Your child’s routine: ______
______
Your child’s favorite blanket or toy: ______
Your child’s fears: ______
Food your child will not eat: ______
Your child’s Favorite Activities: ______
Your child’s habits: ______
Describe the method of discipline used at home:______
- Is your child toilet trained? _____Yes______No ______
Partially (explain)______
- What is the primary language spoken in your home?
______
- What are your expectations of us as your daycare provider:______
______
*Parental Permission Forms*
- Permission for Photographs
I give my permission for my child to have photographs taken for use in the center. Child photographs will not be placed on the Bumble Bear Daycare website.
Signed: ______Date:______
- Parent Confirmation Agreement in Regards to the Parent Handbook
The Parent Handbook is always available at the parent station in the centre .A paper copy is provided upon registration. I agree that I have read, understood and agree to abide by all policies, procedures and writings within the parent handbook.
Signed:______Date:______
- Supervision and Procedures for Walks and Parks (Effective Jan. 1- Dec. 31, 2017)
Parks:
When children go to any of the parks posted in the front entrance (Redwood or Cedar) children will be accompanied by 2 or more teachers regardless of ratios. Children will be paired with a partner and will hold hands with their partner while walking to the park.
The children will line up with partners and one teacher will lead the group at the front of the
line and one will follow the group at the back of the line. If there are more than 2 teachers the other remaining teacher will act as a partner to a child in the middle of the line.
Children who cannot walk will be taken in a stroller by the teacher at the head of the line.
Children will stay on paths and sidewalks and will only cross streets at corners or crosswalks. Once the children arrive at the park the teachers will keep a view of all children from the perimeter of the park and will not stand together ensuring that between all teachers there is a view of all children and the park.
An emergency backpack and a cellphone will go with teachers on all walks to the park. A list of children who are with teachers will be brought and headcounts will be taken before leaving the daycare, upon arriving at the daycare, before leaving the park and again upon arriving back at the center.
Notices will be posted for parents telling them when children are on a walk or at the park. Maps and the cell number of the teacher at the park will also be available for parents.
Walks
The highlighted route map and cell phone number to reach the teacher will be available to parents. Posted on front window.
Children will be paired with a partner and will hold hands with their partner while walking around the community. The children will line up with partners and one teacher will lead the group at the front of the line and one will follow the group at the back of the line. If there are more than 2 teachers the other remaining teacher will act as a partner to a child in the middle of the line.
An emergency backpack and a cellphone will go with teachers on all walks to the park. A list of children who are with teachers will be brought and headcounts will be taken before leaving the daycare, upon arriving at the park, before leaving the park and again upon arriving back at the center.
Children who cannot walk will be taken in a stroller by the teacher at the head of the line.
I have read, understood and agree to the policies above:
Date: ______Signed: ______
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