Register - Maple Nursery School

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Register Your Child

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

Program Selection

* Toddler program operates Monday to Thursday

* Two day program options are available Monday/Wednesday or Tuesday/Thursday. Exceptions may apply

* Three day Pre-school program available Monday/Wednesday/Friday. Exceptions may apply.

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

When do you want to join our Nursery School? *

Immediately
Later Date

Approximate Start Date:

Class Type

Toddler
Pre-School

Days of the Week Attending *

Enter which days of the week for child care

Tax Receipt Required?

Yes
No

Child's Information

Name *

First

Middle

Last

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)

Primary Phone *

Secondary Phone

Work Phone

Place of Employment *

Address of Employment

Address including Postal Code

Parent 2's Information

Name

First

Last

Email

Address (if different from Child)

Primary Phone

Secondary Phone

Work Phone

Place of Employment

Address of Employment

Address including Postal Code

Physician's Information

Provide information in case of emergency

Physician's Name *

First

Last

Physician's Phone *

Physician's Address

Emergency Contacts

Contact #1 Name *

First

Last

Relationship *

Phone *

Address *

Full Address including Postal Code

Contact #2 Name

First

Last

Relationship

Phone

Address

Full Address including Postal Code

Individuals Authorized to Pick up Child

People authorized to pick up your child in your absence.

Contact #1 Name

First

Last

Relationship

Phone

Address

Full Address including Postal Code

Contact #2 Name

First

Last

Relationship

Phone

Address

Full Address including Postal Code

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

Child's Medical Information

The Day Nursery Act 1986 Regulation 160, Section 7 (i) requires the following medical information. This information will be kept in your child's confidential file along with their registration package. Please fill out below. If there are none, simply type N/A or None.

Allergies/Conditions *

List Allergies and Conditions. If none, state "None"

Reaction *

Describe any reactions to look out for

Treatment *

Treatment protocols

Communicable Disease

If your child has ever had a communicable disease such as Measles, Rubella, Chicken Pox or Whooping Cough? If Yes, please indicate which disease(s) and when.

In the Event of an Emergency *

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

Special Considerations

Does your child require any special considerations in respect to diet, rest or exercise? If yes, please describe.

Physical Disabilities

Does your child possess any physical disabilities? If yes, please describe.

Behaviour/Emotional

Does your child possess any emotional disorder or behaviour problems? If yes, please describe.

Medication

Does your child require medication regularly? If yes, please describe.

Other Information

How did you hear about us?

More about you and your child

Any information you want to add about your child? As well, please indicate whether you possess any special skills/talents/opportunities that you feel may benefit Maple Nursery School or the children directly.

Consent

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

Yes
No

CLICK HERE FOR PARENT HANDBOOK

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

Yes
No

Acknowledgement

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

Yes

Date of Submission *

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

Maple Nursery School|2021