Family Registration, Middlesex EarlyON 2021
The information collected on this form is collected pursuant to the Child Care and Early Years Act, 2014, and will be used by Middlesex County Library to fulfill prescribed responsibilities and obligations pertaining to reporting requirements to the City of London as Consolidated Municipal Service Manager of Child and Family Centres. The collection of the information on this form is subject to the provision of the Municipal Freedom of Information and Protection of Privacy Act.

About this Family Registration Form:
Each year, EarlyON Child & Family Centres collect information from families to establish a database of visitors (caregivers and children) to programs. You will only be asked to complete this form once in 2021.

After you complete the family registration form, for each program (virtual or in-person) you attend thereafter in 2021 you will only need to provide the first and last name of each member of your family attending as well as your email. This information will help us determine the total number of annual visits to programs. Provision of your email will allow for us to make contact with you regarding updates to the programs you have registered for.
Email *
Please check if you would like to be added to our email list. We aim to limit our emails to once or twice weekly and limit to information on early years programs and services. *
Your First Name *
Your Last Name *
Your Phone Number: *
I am registering as (please check all that apply): *
Required
Emergency Contact Name *
Emergency Contact Number *
Please select your Municipality of Residence. *
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