Application Forms

Child Information

Full Legal Name*

First Last

Preferred Name

Date of Birth*

Age (years, months)*

Home Address*

Street Address City Postal Code

Language(s) Spoken at Home*

Other children in the family enrolled in the centre

list of names, if applicable

Program Selected*

Toddler (18 months-2.6years)

Preschool (2 ½ -4 years)

Kindergarten (4-6 years)

*3 days programs are run M/W/F *2 day programs are run TH/TH

Parent Information

Parent's Full Legal Name*

First Last

Preferred Name

Relationship to Child*

Email Address*

Primary Phone Number*

Alternate Phone Number

Home Address (if different than child)

Street Address City Province Postal Code

Parent Occupation

Work Name & Address

Parent's Full Legal Name*

First Last

Preferred Name

Relationship to Child*

Email Address*

Primary Phone Number*

Alternate Phone Number

Home Address (if different than child)

Street Address City Province Postal Code

Parent Occupation

Work Name & Address

Custody Arrangements

Are there custody arrangements pertaining to legal right of access to your child?*

Yes

No

If YES, please provide a copy of the appropriate legal documents (e.g.) court order

Names of custodial parent(s)*

Name(s) of individuals prohibited from accessing/picking up your child*

Emergency Contacts

Full Legal Name*

First Last

Preferred Name

Relationship to Child*

Primary Phone Number*

Alternate Phone Number

Home Address*

Street Address City Postal Code

Is this person authorized to pick up your child?*

Yes

No

Full Legal Name

First Last

Preferred Name

Primary Phone Number

Alternate Phone Number

Home Address

Street Address City Postal Code

Is this person authorized to pick up your child?

Yes

No

Full Legal Name

First Last

Preferred Name

Primary Phone Number

Alternate Phone Number

Home Address

Street Address City Postal Code

Is this person authorized to pick up your child?

Yes

No

Medical Information

Additional Emergency Information

Please provide any special medical or additional information about your child that could be helpful in an emergency (e.g., medical conditions, skin conditions, vision/hearing difficulties)

Health Information

If your child has a history of communicable disease (e.g. chicken pox, measles) please list them below

Does your child have any medical needs that requires additional support? (e.g. Diabetes)

Yes

No

If yes, and individualized plan for children with medical needs must be developed between the parent and the school prior the child’s first day.

Immunization Record

An updated copy of your child’s immunization record must be provided to the school prior to your child’s start date.

Family Doctor Information

Doctor/Physician*

First Last

Address*

Street Address City Postal Code

Phone Number*

Allergy Information

Does your child have a life threatening allergy? (e.g. anaphylactic to peanuts or bee strings)*

Yes

No

If yes, an individual plan for an anaphylactic allergy that includes emergency procedures must be developed between the parent and the school prior to child’s start date.

Does your child have any allergies that are non-life threatening? (food or other substances e.g. latex)*

Yes

No

If yes, please provide relevant details, including what your child is allergic to, symptoms of reaction and treatment required:*

*** For Food Allergies and Restrictions please see Allery Form***

Sleep Arrangements

Does your child have any special sleep requirements?*

Yes

No

If yes, please provide relevant details:*

Additional Information

Please provide any additional information that is relevant to the care of your child:*

I/We verify that the information above is correct.*

Parent Verification

Programs

Child Information

Parent Information

Custody Arrangements

Emergency Contacts

Medical Information

Health Information

Immunization Record

Family Doctor Information

Allergy Information

Sleep Arrangements

Additional Information

Cathedral Road

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