CBHA NS-BAP Registration
Nova Scotia Child Care Subsidy Program | Child Care Nova Scotia
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Child's Name *
Grade Level *
Date of Birth *
MM
/
DD
/
YYYY
NS Health Care Number *
Parent/Guardian Name *
Phone Number *
Mailing Address *
Email Address *
Parent/ Guardian Name
Phone Number
Mailing Address If different
Email
Child Resides with
Is there a legal custody agreement?  *
Emergency Contact  *
Phone Number *
Relationship *
Emergency Contact
Phone Number
Relationship
Persons Authorized to pick up child *
Persons Authorized to pick up child
Name of family physician *
Physician Phone Number *
Does your child have any medical concerns/conditions? *
Does your child have any allergies? *
Does your child have any food sensitivities/ restrictions? *
Do you anticipate your child requiring additional support/accommodations to fully participate in group programming? *
Does your child take any medications? If yes please explain *
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