< Back to forms2020 / 2021 School Year 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)