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

    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 City:

    Parent 2 Postal code

    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?

    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.