Shawkwunlee Daycare Registration

Phone

Child Information:

Home Phone:

Date of Birth:

Start Date:

Parent-Guardian 1 Information Name:

Home Phone:

Email

Relation to Child:

Employer:

Work Phone:

Ext

Cell Phone:

Parent-Guardian 2 Information Name:

Home Phone:

Email

Relation to Child:

Employer:

Work Phone:

Ext

Cell Phone:

Authorized Pick Up List Person must be 19 years of age or older and I authorize the following people: (In addition to the Parent/Guardian 1 & 2 information) already listed on page 1) to pick up my child and/or be contacted in case of emergency

Contact #1

Phone

Relationship

Contact #2

Phone

Relationship

Contact #3

Phone

Relationship

The Following People are NOT Authorised to pick up my child

Name

Phone

Name

Phone

Please note that we will ONLY release a child to the people LISTED on this form/emergency permission card. A child will only be released to people not listed, when a staff has received WRITTEN OR VERBAL CONSENT FROM THE PARENT/GUARDIAN confirming that the person is permitted to take the child PRIOR to pick up.

HEALTH INFORMATION:

Family Doctor phone

Health card number:

Please list what is your child allergic to:

What is the reaction of the allergy?

Specific Instructions about the allergy and the reactions:

If an allergy exists you must request the required consent forms for any medication your child may need (ex. EpiPen, Benadryl)

Please specify and give us specific instructions

For medication to be administered at the centre, you must request the required medication consent forms

Social and Behavior information

When filling out this section we encourage parents to give us as much information as possible. Knowing about your child’s social and behaviour requirements before hand allows us to take a proactive approach to their individual needs and therefore help to ensure that they are successful and enjoy the program.

Please explain:

Please explain how you handle the behaviour issues at home so we can work together on it:

Please explain

Field Trips

Parent/Guardian (please print):

Parent/Guardian’s Signature:

Date

Photos and Videos

Parent/Guardian (please print):

Parent/Guardian’s Signature:

Date

Medical Consent

It is the Child Care’s policy to notify a parent when a child is ill or in need of medical attention. Occasionally we are unable to contact parents and we need to get immediate help for the child. Our procedure is to have the child taken to the nearest emergency service by ambulance If an ambulance is not available, the caregiver/staff of the childcare will transport the child.

Parent/Guardian (please print):

Parent/Guardian’s Signature:

Date

Policy Agreement between Shawkwunlee Daycare & Parent/Guardian

Signature (Parent/Guardian)

Date

Signature (Daycare Manager) Danielle Evans

Date

Popular topics:

Popular topics:

Shawkwunlee Daycare Registration

Child Information:

Parent-Guardian 1 Information Name:

Parent-Guardian 2 Information Name:

Contact #1

Contact #2

Contact #3

HEALTH INFORMATION:

Social and Behavior information

Field Trips

Photos and Videos

Medical Consent

Policy Agreement between Shawkwunlee Daycare & Parent/Guardian