KidZone Hourly Playcare - Registration Form

Child's Name (required)

School (required)
Alexander FergusonGlen MeadowsWestgateWildwood

Attending Kindergarten (required)
A.M.P.M.PD Day

Grades 1 to 6 (required)
Before CareAfter CareB/APD Day

*before care not available for Wildwood School*

Date of Birth (required)

Sex (required)
MaleFemale

Alberta Personal Health Card # (required)

Address (required)

Postal Code (required)

Parent/Guardian #1

Name (required)

Address (required)

Postal Code (required)

Home #

Work #

Cell #

Email

Parent/Guardian #2

Name

Address

Postal Code

Home #

Work #

Cell #

Email

Contact and Release Information

In the event of an emergency where I/We cannot be reached, I authorize the following persons to be contacted.

Person 1

Name (required)

Address (required)

Postal Code (required)

Home #

Relationship

Person 2

Name

Address

Postal Code

Home #

Relationship

Person 3

Name

Address

Postal Code

Home #

Relationship

Consent for Medical Treatment

In the event I/We cannot be reached to make arrangements for emergency medical attention at the time of illness or accident, I give consent for KIDZONE to secure any and all necessary emergency medical care for my child.

Parent/Guardian Signature

Immunization up-to-date

YesNo

Please list any additional information such as existing illness, allergies, previous serious illness, injuries during the past 12 months, any medications prescribed for long-term continuous use, and any other information which staff should be aware of.

Permission for my child's picture to appear in either KIDZONE's newsletter and/or website.
YesNo

Parent/Guardian Signature (I have read and agreed with policies and procedures)