REGISTRATION PACKAGE

Please see the registration package below.

Get in Touch

TUNE TOWN CHILD CARE CENTRE

REGISTRATION FORM

Name of Child: _________________________________________________________________

Address: ______________________________________________________________________

Sex: M F Date of Birth: ________________________________________________

Date of Enrollment: _____________________________________________________________

First day of Attendance: __________________________________________________________

End Date: _____________________________________________________________________

Child’s First Language: ________________________ Second Language: ____________________

Other Children living at home: _____________________________________________________

Custody of Child: Mother Father Joint

Parent/Guardian Name: _________________________________________________________

Place of work: __________________________________________________________________

Home Phone: ( )___________________ Work Phone: ( ) ______________________

Cell Phone: ( ) ___________________ Email address: _______________________________

Parent/Guardian Name: _________________________________________________________

Place of work: __________________________________________________________________

Home Phone: ( )___________________ Work Phone: ( ) ______________________

Cell Phone: ( ) ___________________ Email address: _______________________________

If there is a custody agreement in place please attach a copy

Has the child had previous experience away from home?

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Family Doctor _____________________________ Phone: ___________________

Medical Insurance Plan Number ________________________________________

Does the child have any known health problems? __________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________

Are there special instructions from parent or health care professionals??

(Attach documentation)

Are immunizations up to date? _________________________________________

We require a copy of the VIHA basic immunization schedule.

Please note: Tuition fees are due on the 1st of each month. Please provide post-dated cheques for all fees. If you are a recipient of child care subsidy, the difference between our fees and the subsidy amount must be paid on the 1st of the month

ANTICIPATED DROP OFF AND PICK UP TIMES: _______________________________________ ______________________________________________________________________________

ALTERNATE PERSON(S) TO CALL/PICK UP CHILD

Name: ________________________________________________________________________

Relationship to child: ____________________________________________________________

Home Phone: ______________________________ Work: ______________________________

Cell: __________________________________

Name: ________________________________________________________________________

Relationship to child: ____________________________________________________________

Home Phone: ______________________________ Work: ______________________________

Cell: __________________________________

Name: ________________________________________________________________________

Relationship to child: ____________________________________________________________

Home Phone: ______________________________ Work: ______________________________

Cell: __________________________________

PERSONS NOT PERMITTED ACCESS TO CHILD (PLEASE ATTACH DOCUMENTATION)

Name: ________________________________________________________________________

Relationship to child: ____________________________________________________________

Home Phone: ______________________________ Work: ______________________________

Cell: __________________________________