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Maple Nursery School Mission

Maple Nursery School Online Registration

Online Registraion

Child's First Name Surname
Male Female Date of Birth
Address City/Town
Postal Code Unlisted
Email ***REQUIRED FOR COMMUNICATION FROM THE SCHOOL***
Mother's Information
Mother's First Name Surname
Mother's Address
(if different from child's)
City/Town
Postal Code Home Phone Unlisted
Mother's Place of Employment Telephone
Email
Mother's Work Address) City/Town
Postal Code Telephone
Cell Phone
Father's Information
Father's First Name Surname
Father's Address
(if different from child's)
City/Town
Postal Code Home Phone Unlisted
Father's Place of Employment Telephone
Email
Father's Work Address City/Town
Postal Code Telephone
Cell Phone
Do Both Parent's have custody of child Yes No
Family Physician Telephone
Physician Address City/Town
Postal Code Telephone
Individuals to be contacted if parent/guardian cannot be reached
Contact 1
Name
Address
City/Town
Postal Code Telephone Unlisted
Contact 2
Name
Address
City/Town
Postal Code Telephone Unlisted
Individuals authorized to pick up child
Pick Up Contact 1
Name
Address
City/Town
Postal Code Telephone Unlisted
Pick Up Contact 2
Name
Address
City/Town
Postal Code Telephone Unlisted
Names and relationships of people NOT authorized to pick up child
Name
Relationship
Name
Relationship
Please select the program of your choice
  5 Day Monday to Friday AM - 9:00 am to 11:30 am
  3 Day Monday, Wednesday, Friday AM - 9:00 am to 11:30 am
  2 Day Tuesday & Thursday AM - 9:00 am to 11:30 am
  Toddler Tuesday and Thursday AM - 9:00 am to 11:30 am
  Toddler Monday and Wednesday AM - 9:00 am to 11:30 am
  Before school care - 8:30 am to 9:00 am
  After school care - 11:30 am to 12:00 pm
Please select alternate program of your choice if 1st choice isn't available
  5 Day Monday to Friday AM - 9:00 am to 11:30 am
  3 Day Monday, Wednesday, Friday AM - 9:00 am to 11:30 am
  2 Day Tuesday & Thursday AM - 9:00 am to 11:30 am
  Toddler Tuesday and Thursday AM - 9:00 am to 11:30 am
  Toddler Monday and Wednesday AM - 9:00 am to 11:30 am
  Before school care - 8:30 am to 9:00 am
  After school care - 11:30 am to 12:00 pm
Do you wish to participate?
Yes No
If registration were not possible for beginning of session, would you like to be placed on a waiting list?
Yes No
Will you require a tax receipt?
Yes No
How did you hear about Maple Nursery School?
  Facebook
  Mobile Sign
  Parks & Rec
  A Friend
Other
Please indicate below whether you possess any special skills/talents/opportunities that you feel may benefit Maple Nursery School or the children directly
CHILD'S MEDICAL INFORMATION
The Day Nursery Act 1986 Regulation 160, Section 7(i) required the following medical information.
Please complete your child's Record of Immunization

Special medical conditions or known allergies and reaction/treatment of same:


Allery/Conditions

Reaction

Treatment

In the event of an emergency - please adivce as to an individual action plan and the sequence it should occur - (eg. contact parent @ cell phone, administer medication, dial 911) or state how circumstances would dictate depending on the emergency and it would be of the discretion of the person responsible for your child.


Does your child require any special considerations in respect to diet, rest or exercise?
No
Yes
Please describe


Does your child possess any physical disabilities?
No
Yes
Please describe



Does your child possess any emotional disorder or behavior problems?
No
Yes
Please describe



Does your child require medication regularly?
No
Yes
Please describe



Has your child ever had a COMMUNICABLE disease (ie: Measles, Mumps, Rubella, Chicken Pox, Whooping Cough)?
No
Yes
If yes, please indicate which and when

The information given is true, correct and complete to the best of my knowledge.