Parents Center

Please fill out Parent’s Daycare Enrollment Application online

Step 1 - 6

First Name

Last Name

Sex

Address

Home Phone

Birth Date

City

Postal Code

County

Family Information

Father’s Name

Employment

Position

Bus. Phone

Mother’s Name

Employment

Position

Bus. Phone

General Medical Information

Family Physician

Phone No

Physician’s Address

Does student have any physical defects or allergies

YesNo

If yes, explain

Health Card No

Expiry Date

Emergency Telephone Numbers

In case Parents/Guardians cannot be reached, the following people are authorized to pick up the students.

Name

Address

Home Tel

Bus. Tel

City

Province

Postal Code

Name

Address

Home Tel

Bus. Tel

City

Province

Postal Code

Name

Address

Home Tel

Bus. Tel

City

Province

Postal Code

Medical Information / Authorization

Step 2 - 6

Child’s name

Health Card

Expiry Date

Physician’s Name

Physician’s Address

Height of child

Weight of child

In the event that I cannot be reached in a time of illness or accident concerning my child, you are authorized to contact the physician listed below. If the named physician cannot be reached, permission is granted to authorize any doctor to give necessary medical emergency care

Doctor

Address

Telephone

I further consent to my child being transport by a staff member in case of sudden illness or emergency to a private physician or hospital

I understand that if my child appears ill at the day care, my child will be isolated from the other children and given staff supervision until arrangements can be made to pick up my sick child.
I further understand that after my child has been absent from the day care with a serious disease or illness, a signed paper, stating that my child is well enough to return to the day care, is required before my child will be readmitted to the day care.
I understand that the day care staff shall administer medication and special medical procedures only with a written, dated and signed request from my physician. Medication shall be in its original container.
I understand that my child will not be admitted to the day care until a completed medical form is on file. If my child appears to be ill, he/she will not be admitted to the day care. I shall notify the Manager of the day care if the illness is contagious

Record of past communicable diseases

Allergies or other important information:

Has your child had any of the following

Whooping CoughChicken PoxMeaslesMumps

Permission to administer Tempera or Tylenol in the event of a temperature

AboveDosage

*Please attach a copy Immunization Card to the registration package*

hereby agree to the rate quoted at the time of the interview and to the preceding Medical Authorization. I have read, do understand and agree to the policies and procedures as outlined in the Tiara Tiny Tots Daycare Parent Handbook.

Signature of Parent/Guardian

Relationship to child

Date Signed

Childhood History

Step 3 - 6

Name

Date of Birth

Please help us to get to know your child better so that we may best support his/her learning by telling us a little about what you have observed regarding his/her interests, socialization patterns, dislike and anything else that you feel may help us to create the best environment we can for your child

1. Describe your child at play.

2. What type of activities does your child enjoy while at home?

3. Describe your child’s eating habits/routines.

4. Describe your child’s bed/nap time routine.

5. Describe your child’s washroom routine pattern.

6. What is your child’s experience with books?

7. Does your child enjoy creating things?

8. Does your child like to sing, dance, and dramatize?

9. Does your child have any siblings? If yes, how does he get along with them, and what are their names?

10. Please note any other things that you think we should know about your child. For example, does your child speak another language other than English? Are there any cultural traditions, customs and celebrations that your child engages in that you feel we should know of?

Child Pick Up

Step 4 - 6

Please list the names of those individuals who you have given permission to pick up your child up from the centre in the event that you are unable to pick up your child yourself.

These people will need to show identification prior to your child leaving the premises.

Name

Relationship to child

Name

Relationship to child

Name

Relationship to child

Password

Parent(s)/Guardian(s) Signature(s)

Application processed on

Date of Admission

Date of Withdrawal

Photographs

I understand that my childcare provider may at times take photos of the children’s activities as part of their program. I give my permission for my child’s photo to be taken.

Parent(s)/Guardian(s) Signature(s)

I/We

have read and commit to comply with the aggression-free philosophy of the day care

Parent’s Signature

Date

I hereby certify that all information in this application is true and correct to the best of my knowledge. I understand that should the above information be proved false, it may result in the rejection of my child’s application and enrollment in Tiara Tiny Tots Daycare.

Signature

Name

Date

Emergency Form

Step 6 - 6

First Name

Last Name

Home Phone Number

Date of Birth

Sex

City

Postal Code

Address

Doctor Details

Doctor’s Name

Phone Number

City

Postal Code

Address

Mother’s Details

Mother’s Name

Home Phone

Work Phone

Cell Phone

Father’s Details

Father’s Name

Home Phone

Work Phone

Cell Phone

In case of emergency who should we contact?

Name

Phone Number

Name

Phone Number

Can we give your child Tylenol, aspirin, or Pepto Bismol?

YesNo

Does your child have any allergies or medical conditions?

Additional Comments

Choosing a quality child care program is one of the most important decisions you will make for your family.

Please fill out Parent’s Daycare Enrollment Application online

Step 1 - 6

Family Information

General Medical Information

Emergency Telephone Numbers

Medical Information / Authorization

Step 2 - 6

Childhood History

Step 3 - 6

Child Pick Up

Step 4 - 6

Photographs

Information sheet

Step 5 - 6

Health

Nutrition What food does your child:

Toileting Is child trained for:

Rest

Siblings

Care

Emergency Form

Step 6 - 6

Doctor Details

Mother’s Details

Father’s Details

In case of emergency who should we contact?

Tiara Tiny Tots Childcare

Opening Hours

Contact Details