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KidZone Hourly Playcare - Registration Form


Alexander FergusonGlen MeadowsWestgateWildwood


A.M.P.M.PD Day


Before CareAfter CareB/APD Day

*before care not available for Wildwood School*


MaleFemale

Parent/Guardian #1

Parent/Guardian #2

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

Person 2

Person 3

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.

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.


YesNo