bearspawpreschool@gmail.com
(403) 239-4441
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3 Year Old Preschool Program
4 Year Old Junior Kindergarten
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CONTACT
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Registration Form
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
*
Male
Female
Address/PC:
*
AB Health:
*
Date of Birth (Month, Day, Year):
*
City
*
Home phone:
*
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:
*
Zip / Post Code
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?
*
Yes
No
Is your child taking any medication on a regular basis? (e.g. epi-pen, insulin)
*
Yes
No
Does Your Child Have Physical Disabilities?
*
Yes
No
Does Your Child Have Medical Issues?
*
Yes
No
Is there any other important health information?
*
Yes
No
Additional Health Information:
*
ALLERGY ALERT
Allergen(s):
*
Symptom(s):
*
Procedure:
*
CLASS CHOICE
Preferred Class Choice (First Class)
*
3-Year-Old AM - No teacher Preference
3-Year-Old PM - No teacher Preference
4-Year-Old AM - No teacher Preference
4-Year-Old PM - No teacher Preference
3-Year-Old AM - Chamberlin
3 Year-Old AM - Corey
3-Year-Old PM - Chamberlin
4-Year-Old AM - Chamberlin
4-Year-Old AM - Corey
4-Year Old PM - Chamberlin
4-Year Old PM - Corey
Secondary Class Choice
3-Year-Old AM - No Teacher Preference
3-Year-Old PM - No Teacher Preference
4-Year-Old AM - No Teacher Preference
4-Year-Old PM - No Teacher Preference
No Secondary Class Chosen
3-Year-Old AM - Chamberlin
3-Year-Old AM - Corey
4-Year-Old AM - Chamberlin
4-Year-Old AM - Corey
4-Year-Old PM - Chamberlin
4-Year-Old PM - Corey
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 Interested
President
Vice President
Secretary
Treasurer
Registrar
Special Events
Casino
Website / Social Media
Classroom 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.
Registrations Open on January 13th, 2019
