Form

Registration Form

Name of Child *

First

Last

Child's Birthday (D/M/Y)

Gender

Alberta Health Card #

Starting Date (D/M/Y)

Child's Address

Required Hrs of Service (from..to...)

Parent/Guardian Name *

First

Last

Relationship to Child *

Home Address with Postal Code *

Phone Number

Employers Name and Address

Work Phone *

Cell Phone *

Email Address *

Parent/Guardian Name (copy) *

First

Last

Relationship to Child *

Home Address with Postal Code *

Phone Number

Employers Name and Address

Work Phone *

Cell Phone *

Email Address *

Emergency Contact (Persons Daycare Staff can release child to) *

First

Last

Relationship to Child *

Home Address with Postal Code *

Phone Number

Work Phone *

Cell Phone *

Email Address *

Emergency Contact (Persons Daycare Staff can release child to) *

First

Last

Relationship to Child *

Home Address with Postal Code *

Phone Number

Work Phone *

Cell Phone *

Email Address *