Please ensure all required fields are completed.
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:

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 City:

Parent 2 Postal code

Parent 2 Email:

Parent 2 Work phone:

Parent 2 Home phone:

Parent 1 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?

YesNo

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:


CLASS CHOICE

Preferred Class Choice (First Class)

Secondary Class Choice


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

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