Child's Profile

Child's Name:
Nickname or any preferred name:
Gender: MaleFemale
Date of Birth:
Address:
Alberta Health Care Number:
Physician's Name:
Physician's Contact Number:
Is your child's immunization up to date? YesNo
General state of health:
Any known allergies:
Symptoms/reactions of allergies:
Medication required if any:
Are you concerned that you child may be prone to any type of allergies? Please describe:
Does your child have any medical conditions which we should be made aware of:
Does your child have any speech, hearing or visual problems? Please describe:
Would there be any restriction to play or activities?

Mother's Profile

Name:
Marital Status:
Address:
Contact Information:
Home Phone:
Cell Phone:
Email:
Occupation:
Work Address:
Work Phone:

Father's Profile

Name:
Marital Status:
Address:
Contact Information:
Home Phone:
Cell Phone:
Email:
Occupation:
Work Address:
Work Phone:

Emergency Contact

(Person other than Parents/Legal Guardian)
Name of first contact:
Relation to child:
Address:
Contact Information:
Home Phone:
Cell Phone:
Name of the second contact:
Relation to child:
Address:
Contact Information:
Home Phone:
Cell Phone:

Authorized Person to Pick up the Child

(Govt. Issued Photo ID Required)
Name:
Relation to child:
Address:
Contact Information:
Home Phone:
Cell Phone:
Name:
Relation to child:
Address:
Contact Information:
Home Phone:
Cell Phone:

Child's Personality

1. Has your child been in a childcare before? If yes, what was the experience?
2. What are your expectations from our daycare:
3. Any specific goals for child:
Physical Goals:
Character Goals:
4. What are your child’s favourite activities, toys, books, or games?
5. What is your normal method of discipline?
6. What is your child's temperament: Easy goingHard to PleaseDemandingAggressiveOther
If other please specify:
7. What is your child’s favourite food?
8. Are there any food restrictions?
9. Child scared of:
10. Child’s reaction when he/she is in stress:
11. Which language(s) do you speak at home?
12. Religious Background:
13. Any other concerns, comments or information you would like to share:

Terms and Conditions

I/we understand that

  1. Daycare Centre will open at 6:30 am and close at 6:00 pm.
  2. I/we must provide the complete medical information to the daycare.
  3. If the Parent/Legal guardian is unable to pick up their child, they are required to arrange another arrangement for pickup. At the time of pick up, the person will be asked to show government issued photo ID.
  4. Fees are due on the first business day of each month and must be paid in time in order to avoid late charges of $5.00 per day. Full fees must be paid regardless of sickness or holidays.
  5. Parents are responsible to make sure that their subsidy is valid at all time. Please send in your renewal and all requiring documents for subsidy one month before the expiry date to avoid disappointment.
  6. I grant permissions for my child to leave the facility under the supervision of the staff members for drills, neighborhood walks, sledding, outdoor play area etc. A consent form will also be provided for field trip.
  7. I grant permissions for photo of my child to be taken and use them. These photos will be used only for facility purposes and display on bulletin boards or on daycare website.
  8. I grant my permission for applying sunscreen and bug spray to my child before goingout of the facility according to the weather. Parents are responsible to provide sunscreen and bug spray for their child. Please label any bottles with your child’s name.
  9. We require sending an extra set of clothes, indoor shoes to be left at the daycare or brought everyday according to the season. Children must be dressed appropriately for the weather, as they are taken outside every day, weather permitting.
  10. Weather permitting outdoor play is part of facility’s daily program. Parents will ensure that child is sent with proper clothing according to weather.
  11. One-month written notice is required when you withdraw your child from the Centre. Failure to provide the written notice will result in owing fees for that month.
  12. The Centre reserves the right to terminate immediately the enrollment agreement and application of my child who has caused the disruption of the progress of facilityprogram.
  13. I/we further understand that if the polices outlined in the handbook were not adhered to, it would be sufficient cause for the removal of the child/children fromthe childcare program.
  14. I will directly communicate to the Director/Owner whatever concerns or suggestions I have.
  15. Please provide copies of custody agreement if any.
  16. Daycare will be closed on all the statutory holidays in Alberta and one week for the Christmas holidays.

I/we have read, understand and agree to abide by the above term and conditions and the policies contained in the parent’s handbook of Kidz Junction Daycare and Out of School. I/we gave permission to Kidz Junction to provide acre to my child/children.

Parent/Legal Guardian Name:
Date:

Comments: