Register - Maple Nursery School

Please fill out this form to register your child. * Denotes required items. FULL ADDRESSES INCLUDING POSTAL CODES ARE REQUIRED.

Program Selection

Our 2024/2025 School year starts on September 9, 2024 and ends on June 12, 2025.

Programs run from 9:00am to 11:30 am.

The toddler program is for children 18 months to 2.5 years of age and operates Monday to Thursday.

The pre-school program is for children 2.5 years to 5 years of age and operates Monday to Friday

If your program of choice is not available you may be placed on a waiting list.

Desired Start Date *

Immediately
Later Date

Class Type

Toddler
Pre-School

Requested Days of Care *

Toddler- 2 days: M/W or T/Th or 4 days: M/T/W/Th.

Preschool - 2 days: M/W or T/Th, 3 days: M/W/F or T/TH/F, 4 days: M/T/W/TH or 5 days - M/T/W/TH/F

Child's Information

Name *

First

Last

Preferred Name

Date of Birth *

Address *

Full Address Including Postal Code

Gender *

Parent Information

Do both parents have custody of the Child? *

Yes
No - Parent 1 has sole custody
No - Parent 2 has sole custody

Parent 1's Information

Name *

First

Last

Email *

Address (if different from Child)

Cell Phone *

Home Phone

Work Phone

Place of Employment *

Parent 2's Information

Name

First

Last

Address (if different from Child)

Cell Phone

Home Phone

Work Phone

Place of Employment

Physician's Information

Provide information in case of emergency

Physician's Name *

Physician's Phone *

Emergency Contacts

The emergency contact cannot be a parent or primary guardian that is already listed. The teachers will always call the parents/primary guardians first, and in the event that they cannot be reached they will call the emergency contact.

Contact #1 Name *

First

Last

Relationship *

Phone *

Contact #2 Name

First

Last

Relationship

Phone

Individuals Authorized to Pick up Child

If your child will be picked up by someone other than a parent, they must be authorized to do so.

Contact #1 Name

First

Last

Relationship

Phone

Contact #2 Name

First

Last

Relationship

Phone

Individuals NOT Authorized to Pick Up Child

List anyone NOT authorized to ever pick up your child.

Not Authorized Contact #1

First

Last

Relationship

Not Authorized Contact #2

First

Last

Relationship

Immunization Records

In order to attend day care in Halton Region, your child’s immunization records must be submitted to Halton Public Health (http://www.halton.ca/immunize) and a copy must be provided to the child care centre for the child's physical file. If you decide not to vaccinate, a notarized letter of consent must be provided. More information will be provided upon request.

Child's Medical Information

The Child Care and Early Years Act, 2014 requires the following medical information on file. Please fill out below. If there are none, simply type N/A or None.

Does your child have any allergies (food, medical, insects, etc)? *

If yes, please include their reaction and treatment.

Does your child have any health problems? *

Please explain.

Does your child take any regular medications? *

Please explain.

Does your child undergo regular medical treatment (including hearing, vision, speech)? *

Please explain.

Does your child require any special diet, rest or exercise considerations? *

Please explain.

Is there any other medical or physical information about your child you wish to provide? *

Please explain.

Do you have any concerns about your child's development or behaviour? *

Please explain.

Has your child ever had a communicable disease such as hepatitis, measles, mumps, rubella, whooping cough? *

If Yes, please indicate which disease(s) and when.

Individual Action Plan

If you child has a special medical condition (including but not limited to allergies), please indicate the condition, specific warning signs or symptoms, triggers (if applicable) and emergency measures to be taken. Additional documentation is required to anaphylactic allergies, asthma or medications required to be taken during care.

Other Information

How did you hear about us?

More about you and your child

Any information you want to add about you or your child? Do you celebrate any specific holidays or cultural events that we should be aware of?

Consent

I provide consent for Maple Nursery School to post photos of your child on our private Parent Facebook Group? *

We would like to share photos of the children on our private parent facebook group as documentation of their time in care. Photos will not be shared publicly.

CLICK HERE FOR PARENT HANDBOOK

I have received and will read the Parent Handbook. Clickable link above that opens in a new window/tab. *

Acknowledgement

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

Date of Submission *

You will receive a copy of this application by the email provided in Parent #1 field.