Early Head Start 2020 - 2021 Registration Form - LaSalle
Please fill out all the boxes below to register for the Early Head Start Program. To see other CCS Programs please visit https://ccs-montreal.org/children-families/
Email *
Child's name (first and last) *
Child's current address: street name, number, and apartment number *
City *
Province *
Postal code *
Telephone number *
Child's age *
Child's date of birth *
Child's gender *
Preferred language of communication *
Does your child have any allergies or health concerns we should be aware of? *
Parent/Guardian 1 name (first and last) *
Parent/Guardian 2 name (first and last)
Number of classes a week you'd like to attend *
Please check off which days you would like to participate in the program (all classes are from 9:30-11:45) *
If there is anyone other than a parent or guardian who will be picking up your child at anytime, please list their name, phone number, and relationship to your child below:
In case of emergency please contact: Name (first and last) *
Relationship to child *
Phone number *
Is there anything else you would like us to know about your or your child?
Collective Community Services Photo Authorization *
Today's date *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy