REGISTRATION PACKAGE

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: __________________________________