If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Child’s Name: First Name * Last Name * Gender * MaleFemale Address/PC: * AB Health: * Date of Birth (Month Day, Year): * City * Home phone: * Student Class: * 3 Year Old Morning 3 Year Old Afternoon 4 Year Old Morning 4 Year Old Afternoon Class Division * - Select - 3 Year Old 4 Year Old First Parent Name Parent’s Name: Parent 1 First Name * Parent 1 Last Name * Parent 1 Address: * Parent 1 City: * Parent 1 Postal code: * Parent 1 Email: * Parent 1 Work phone: * Parent 1 Home phone: * Parent 1 Cellphone: * Second Parent Name Parent’s Name: Parent 2 First Name * Parent 2 Last Name * Parent 2 Address: * Parent 2 Postal code: * Parent 2 City: * Parent 2 Email: * Parent 2 Work phone: * Parent 2 Home phone: * Parent 2 Cellphone: * ALTERNATE EMERGENCY CONTACT Emergency Contact First Name * Emergency Contact Last Name * Emergency Contact Address: * Emergency Contact City/PC: * Emergency Contact Relationship: * Emergency Contact Main phone: * Emergency Contact Work phone: * Emergency Contact Alternate phone: * HEALTH INFORMATION Has your child been immunized? * Yes No Does your child have any allergies? * YesNo Is your child taking any medication on a regular basis? (e.g. epi-pen, insulin) * YesNo Does Your Child Have Physical Disabilities? * YesNo Does Your Child Have Medical Issues? * YesNo Is there any other important health information? * YesNo Additional Health Information: * ALLERGY ALERT Allergen(s): * Symptom(s): * Procedure: * OTHER How have you heard about us? * Are you interested in supporting our Bearspaw Preschool Society? Which position(s) would you be interested in help with ? Not InterestedPresidentVice PresidentSecretaryTreasurerRegistrarSpecial EventsCasinoWebsite / Social MediaClassroom Coordinator CONSENT Medical Emergency Consent * I, hereby give authority for my child’s teacher to take the necessary steps to ensure that my child receives the care needed in any medical emergency. I also understand that I would be contacted immediately when any care is required. Please be aware that, in the event that 911 is called and an ambulance is dispatched, the parents will incur any related costs. Personal Information Consent * I, hereby give permission for the preschool to publish my child’s full name and phone number for the purpose of providing class lists to currently enrolled families.