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1. Registration Information

Child's Name

Sex

Child's Date of Birth

Home Phone

Street / Apt #

City

Postal Code

2. Parent / Guardian 1

Parent / Guardian Name

Home Address Same as Child?

YesNo

Street / Apt #

City

Postal Code

Phone Number

Alternate Phone Number

Business Name

Business Phone

3. Parent / Guardian 2

Parent / Guardian Name

Home Address Same as Child?

YesNo

Street / Apt #

City

Postal Code

Phone Number

Alternate Phone Number

Business Name

Business Phone

4. Custody Arrangements

Are there custody arrangements pertaining to legal right of access to your child?

YesNo

If Yes, please provide details

Name(s) of custodial parent(s)

Name(s) of individuals prohibited from accessing/picking up your child

5. Emergency Contact #1

Full Legal Name

Relationship to Child

Primary Phone Number

Alternate Phone Number

Home Address

Authorized to Pick Up Child?

YesNo

6. Emergency Contact #2

Full Legal Name

Relationship to Child

Primary Phone Number

Alternate Phone Number

Home Address

Authorized to Pick Up Child?

YesNo

7. Authorized Pick-Up Persons

Authorized pick-up persons may be required to show ID.

Person 1

Name

Home Phone

Business Phone

Cell Number

Person 2

Name

Home Phone

Business Phone

Cell Number

Person 3

Name

Home Phone

Business Phone

Cell Number

8. Doctor's Information

Physician's Name

Telephone Number

Physician's Address

Health Card Number

9. Health History

Does your child have a history of communicable diseases and/or any other health issues?

Is your child under any medical treatment and/or taking any regular medication?

Is there any medical condition about your child that the centre should know about?

Are there any specific behaviors that the staff should be aware of?

Are there any special requirements for diet, rest, exercise, etc.?

Is there any information the staff and child care centre should know about your child's development?

Does your child currently benefit from early intervention services offered by York Region?

YesNo

If Yes, please explain

Any other additional information you feel would be beneficial for the staff and child care centre to know

10. Allergies

Please list any allergies your child has

What is the reaction to the above allergies? Please explain in detail.

How should staff respond should your child have a reaction while in care?

Are there any food substitutes that may be served to your child in place of the food allergy?

11. Rest Period

The quiet rest period at Two Trees Child Care Centre is from 12:30 – 2:30.

If your child requires an alternative sleep schedule, please indicate specific instructions

12. Child's Information

Does your child have any siblings and what are their ages?

Does your child nap at home? What times?

Does your child have a special blanket or toy for sleep time?

Language(s) spoken at home

Child's favourite foods

Dislikes

Has your child ever been separated from you?

Is your child used to other children?

How does your child play with others?

Very WellNot WellPlays Alone

What are your child's favourite toys/activities?

How does your child express him/herself when he/she is upset?

Is your child in diapers? Toilet trained? Please explain.

Words Your Child Uses

Urination

Bowel Movement

How do you discipline your child at home? How do they normally react?

Who will normally pick up and drop off your child?

13. Consents / Policy Sign-Off

Emergency Treatment / Medical Care

Parent Initials

I give permission for the Director, Supervisor and/or staff to take whatever steps necessary to obtain emergency medical care if warranted.

Neighbourhood Walks / Program Activities / Field Trips

Parent Initials

I acknowledge and give permission for my child to participate in supervised neighbourhood walks, field trips and other activities/events outside the child care centre.

Centre Program / Pictures / Videos

Parent Initials

I grant permission for my child to participate in centre activities and for photos/videos to be used as described in the registration package.

Discharge Policy

Parent Initials

Fees Policy

Parent Initials

Non-Prescribed Medication

Parent Initials

Immunization Record

Parent Initials

Part Time Care Policy

Parent Initials

Allergies & Dietary Restrictions

Parent Initials

Late Fee Policy

Parent Initials

Drop Off Policy

Parent Initials

Price Increase

Parent Initials

Consent

Parent Initials

14. Policies and Procedures / Terms of Agreement

I have received, read, understand and agree to abide by the Policies, Procedures and Program Statement as well as the Terms of the Agreement stated on the registration forms and listed in the Two Trees Child Care Centre Parent Manual.

15. Parent Signatures

Date

Parent 1 Name

Parent 1 Signature

Parent 2 Name

Parent 2 Signature

16. Infant Care Instructions

Child's Name

Date of Birth

Formula Brand

Morning

Time

Amount

Noon

Time

Amount

PM

Time

Amount

Other

Time

Amount

Other Instructions

Infant Sleep Instructions

Nap #1 Time

Nap #1 Length of Nap

Nap #2 Time

Nap #2 Length of Nap

Nap #3 Time

Nap #3 Length of Nap

Tips for putting my child to sleep

Parent Signature

Date

17. Centre Communication App Photo Release

Two Trees Child Care Centre uses BRIGHTWHEEL as its main source of communication.

Please select one:

Yes, I give consentNo, I do not authorize

Parent Signature

Date

Child's Name

18. Child's Emergency Contact Information

Date Last Updated

Child's Information

Full Legal Name

Preferred Name

Date of Birth

Special Medical or Additional Information Helpful in an Emergency

Parent 1 & Parent 2

Parent 1 Full Name

Preferred Phone Number

Alternate Phone Number

Parent 2 Full Name

Preferred Phone Number

Alternate Phone Number

Emergency Contact 1 & Emergency Contact 2

Full Legal Name

Preferred Phone Number

Alternate Phone Number

Authorized To Pick Up

YesNo

Full Legal Name

Preferred Phone Number

Alternate Phone Number

Authorized To Pick Up

YesNo

Additional Authorized Pick-Up Persons

Full Legal Name

Phone Number

Full Legal Name

Phone Number

Please review all information carefully before submitting.

3 Simple Steps to Get Started

Parent Handbook

Registration Package

1. Registration Information

2. Parent / Guardian 1

3. Parent / Guardian 2

4. Custody Arrangements

5. Emergency Contact #1

6. Emergency Contact #2

7. Authorized Pick-Up Persons

Person 1

Person 2

Person 3

8. Doctor's Information

9. Health History

10. Allergies

11. Rest Period

12. Child's Information

Words Your Child Uses

13. Consents / Policy Sign-Off

Emergency Treatment / Medical Care

Neighbourhood Walks / Program Activities / Field Trips

Centre Program / Pictures / Videos

Discharge Policy

Fees Policy

Non-Prescribed Medication

Immunization Record

Part Time Care Policy

Allergies & Dietary Restrictions

Late Fee Policy

Drop Off Policy

Price Increase

Consent

14. Policies and Procedures / Terms of Agreement

15. Parent Signatures

16. Infant Care Instructions

Morning

Noon

PM

Other

Infant Sleep Instructions

17. Centre Communication App Photo Release

18. Child's Emergency Contact Information

Child's Information

Parent 1 & Parent 2

Emergency Contact 1 & Emergency Contact 2

Additional Authorized Pick-Up Persons