Which program are you registering for? *

Child's Last Name *

Child's First Name *

Child's Address *

Child's Birthdate *

Child's Gender *

Child's Healthcare Number *

Primary Parent Contact Name (First & Last) *

Primary Parent Contact Address *

Primary Parent Contact Phone Number (include home, work, cell) *

Primary Parent Contact E-mail *

Emergency Contact Name *

Emergency Contact Phone Number *

Emergency Contact Address *

Family Physician Name, Phone Number and Address *

Does your child have any medical conditions, special needs, developmental or speech delays? *

If Yes to the above question please describe

Is English a second language for your child? *

Does your child require medication that must be given on a daily basis? *

If yes, please state what the medication is and why it is given:

Does your child have all their immunizations up to date? *

Any Allergies? If yes, please complete the asthma alert & allergy alert form prior to start *

I hereby grant permission to Westridge Wolf Willow Playschool to seek emergency medical care for my child if deemed necessary by the playschool teachers. I understand that may child may be transported to a medical facility where treatment may be given. I understand that the playschool will attempt to notify me but I recognize the playschool is not legally responsible for any such medical aid administered to my child or possibly ambulance costs. *

I give permission for my child to leave the premises for walks, visit the playground etc. *

I authorize the distribution of my child's name, my name, email, and phone number for a class directory. *

I give permission for pictures to be taken of my child and shared with other registered families in my child's class. *

I understand my child must be toilet trained by the first day of school (no pull ups). *

I understand the playschool relies on funds generated at a volunteer run casino event, once every two years. I will be asked to provide one person to represent our family at this fundraising event. *