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.

Enter number of days per week
Enter which days of the week for child care

*Note: Duty Parent spots may be limited or filled by other parents.

Child's Information

Full Address Including Postal Code

Parent Information


Parent 1's Information

Address including Postal Code

Parent 2's Information

Address including Postal Code

Physician's Information

Provide information in case of emergency

Emergency Contacts

Full Address including Postal Code

Full Address including Postal Code

Individuals Authorized to Pick up Child

People authorized to pick up your child in your absence.
Full Address including Postal Code

Full Address including Postal Code

Individuals NOT Authorized to Pick Up Child

List anyone NOT authorized to ever pick up your child.


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.
List Allergies and Conditions. If none, state "None"
Describe any reactions to look out for
Treatment protocols
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, 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.
Does your child require any special considerations in respect to diet, rest or exercise? If yes, please describe.
Does your child possess any physical disabilities? If yes, please describe.
Does your child possess any emotional disorder or behaviour problems? If yes, please describe.
Does your child require medication regularly? If yes, please describe.

Other Information

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

Acknowledgement

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