Preschool of the Arts Registration Form
Email address *
Child's Name *
first, last
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Home Address *
street address, city, postal code
Your answer
Child's Home Telephone Number
Your answer
Parent / Caregiver 1
Name (s) of Parent / Caregiver 1 *
First, Last
Your answer
Home Address of Parent / Caregiver 1 *
street address, city, postal code
Your answer
Cell Phone of Parent / Caregiver 1 *
include area code
Your answer
Email Address of Parent / Caregiver 1 *
Your answer
Place of Employment of Parent / Caregiver 1 *
if n/a please indicate "None" in the box
Your answer
Work Phone Number of Parent / Caregiver 1 *
include area code or if n/a please indicate "None" in the box
Your answer
Work Address of Parent / Caregiver 1 *
Street Address, City, Postal Code or if n/a please indicate "None" in the box
Your answer
Names and Ages of other Children in the Home *
if n/a please indicate "None" in the box
Your answer
Parent / Caregiver 2
Name (s) of Parent / Caregiver 2
First, Last
Your answer
Home Address of Parent / Caregiver 2
street address, city, postal code
Your answer
Cell Phone of Parent / Caregiver 2
include area code
Your answer
Email Address of Parent / Caregiver 2
Your answer
Place of Employment of Parent / Caregiver 2
if n/a please indicate "None" in the box
Your answer
Work Phone Number of Parent / Caregiver 2
include area code or if n/a please indicate "None" in the box
Your answer
Work Address of Parent / Caregiver 2
Street Address, City, Postal Code or if n/a please indicate "None" in the box
Your answer
Names and Ages of other Children in the Home 2
if n/a please indicate "None" in the box
Your answer
Emergency Contact
Names Emgergency Contact *
Must be other than parents, we ALWAYS contact parents first
Your answer
Address of Emgergency Contact *
Your answer
Phone of Emgergency Contact *
Your answer
Relationship of Emergency Contact to Child *
Your answer
Persons to Whom my Child May be Released
First Contact
Your answer
Second Contact
Your answer
Third Contact
Your answer
My Child also Attends
Your answer
Additional Information (e.g. seperation, divorce, adoption)
Your answer
Preschool September 2018 Registration Schedule
Please check the Preschool classes you are signing up for:
8:15 am - 8:55 am (Early Drop)
9:00am -11:30am
11:30 am - 12:00 pm (Later Pick Up)
1:00 pm - 3:30 pm
9:00 am - 2:55 pm
Monday
Tuesday
Wednesday
Thursday
Friday
Medical Information
Ontario Health Card Number *
Your answer
Doctor's Name *
Your answer
Doctor's Telephone Number *
please include area code
Your answer
Doctor's Address *
Your answer
List Child's Allergies *
if n/a please indicate "None" in the box
Your answer
Are any of the Allergies Life Threatening? *
Special Medical Conditions we should be aware of *
if n/a please indicate "None" in the box
Your answer
Communicable diseases my child has had *
if n/a please indicate "None" in the box
Your answer
I hereby grant permission for photos of my child to be taken during class and used on the Preschool of the Arts website and facebook page. *
Required
I hereby grant permission for photos of my child to be taken during class and used on the Preschool of the Arts password protected Parent Portal. *
Required
I give my permission for my child to receive treatment for a medical emergency. *
Required
I give my permission for my child to go for a walk with Preschool of the Arts’ staff for programming. I understand that he/she might leave the school property. *
Required
I agree to give one month's notice in writing for any withdrawal. *
Required
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