Junior Kindergarten

REGISTRATION FORM

Name of Child:

City:

Date of Birth:

Postal Code:

Sex of Students

Male Female

Address:

Cellular or Pager:

Mother's Name:

Mother Phone No:

Occupation:

Employer:

Mother E-Mail Address:

Father's Name:

Occupation:

Father Phone No:

Father E-Mail Address:

Cellular or Pager:

Employer

Person(s) whom child lives with:

If there is a Custody Agreement, please give details:

Persons Authorized to pick up child from Child Care and Emergency contacts(other than parents):

Phone No.

Name

Address

Please Note: We Will Not Release Your Child To Anyone Who Is Not On The List
If we have not seen/met person on the list we will need a picture ID with full name of individual
before we release the child. Your emergency contact will be contacted in case of emergency if
you cannot be reached.

Sibling Information

Name

Birthday

Relationship

Languages Spoken in the Home:

Do you have any customs or religious beliefs of which you feel we should be aware?

Tell us about your child;

Has your child had any type of group experiences before?

Guidance and Behaviour

Please list three positive characteristics about your child

Is your child afraid of anything? If yes, please provide details;

Do you have any concerns about your child's present behaviour? If yes,please provide details;

Does your child have any current diagnosis or intervention? Please disclose fully so that we are aware of the support your child will need. If your child needs one to one support, please let us know to make sure we are able to support this request and provide assistance or help set up referrals with Child Development Services.

Health Information

Immunizations:Please fill the dates or Attach copy of health book

Is your child immunized (please circle):

Yes No

Age	DTaP-HBIPV-Hib	Pneumococcal	MMR	Meningococcal C	Varicella	Rotavirus	Influenza	Help A
2 mos			N/A		N/A		N/A	N/A
4 mos			N/A	N/A	n/a		N/A	N/A
6 mos		N/A	N/A	N/A	N/A	N/A	N/A
12 mos	N/A					N/A		N/A
18 mos		N/A	N/A	N/A	N/A	N/A	N/A	N/A

Child’s Care card #

Past Illnesses:

Chicken Pox

Whooping Cough

Rheumatic Fever

Mumps

Measles

Other

Does your child have any allergies?

Yes No

Are the allergies life threatening-(Anaphylaxis):

Yes No

If your child has Allergies (Mid or services) Please Sign the following Two forms:
1. Allergy anaphylaxis forms
2.Allergy data collection form

Is your child on a special diet?

Special Foods?

Reason for Special Diet?

Speech Difficulties:

Has your child been under a doctor’s care for any prolonged time? Explain

Family Doctor:

Telephone

Doctor's Address:

Telephone:

Family Dentist:

KIDZVILLE LEARNING CENTERS
CONSENT FORMS & CHILDCARE AGREEMENT

, give permission for my child,

to take part in the following:

I give my consent to Kidzville learning Centres to take my child’s pictures either themselves or by an external photographer while at their care. These pictures may be used on the school’s website or school’s advertising brochures. The pictures will be property of the school.

I give my consent to have my child treated by a physician for medical care and to be transported to hospital by ambulance should an emergency arise. I understand that every effort will be made to contact my spouse or me before such action is take.

In case of injury to my child while in care of Kidzville Learning Centers, I hereby waive all claims against the school in excess of public liability insurance ($5,000,000) carried by Kidzville learning Centre (Division of Panorama Ridge Montessori)

I agree to make payment for tuition on the 1st of every month by submitting banking info and one void cheque to process an automatic withdrawal from my banking account to Kidzville Learning Centers. I am required to give pay one full month deposit which will applied to the last month of my child's attendance.

For Junior Kindergarten program (ages 3-5yrs.)-all withdrawal notices must be given one full calendar month in advance. In absence of one full calendar month's notice, the registration deposit will not be refunded. (Example: If you child wishes to withdraw starting December 1st, withdrawal notice MUST be received by October 31st.)

There will be a $45.00 charge on all returned (N.S.F.) fees.

A $75.00 registration fee is required to ensure your child a place and is not refundable. There will be no refund on monthly fees or any portion thereof, regardless of sickness, school holidays or family vacations.

Any decrease in number of days of attendance requires one full calendar months' notice.

Signed:

Date:

www.kidzvillelearningcenters.com

info@kidzvillelearningcenters.com

www.facebook.com/PRmontessori

PH : (604) 861-7861

CONSENT FORM NATURE WALKS AROUND SCHOOL

, give permission for my child,

to take part in Nature

Walks around and near the school grounds. I know that all safety measures will be in place and the staff of Kidzville will be present on such trips and outings. I waive all liabilities from Kidzville Learning Center in case of any accidents or injury that may
occur.

Parent’s signature

Date

kidzvillelearningcenters.com

info@kidzvillelearningcenters.com

www.facebook.com/PRmontessori

PH : (604) 861-7861

CONSENT FORM

It is the policy of this center to notify a parent when a child is ill or needs medical attention.In the event we cannot contacr you and we need to get help for your child we require a signed consent to do so.

1. I give consent for my child to be taken to the nearest emergency medical center when i cannot be contacted.
2. I give consent for my child to receive medical treatment.

Signature of parent/Guardian

Date

Personal information contained on this form is coolected under the community care and Assisated living Act and willbe used only for the purpose indicated.

EMERGENCY CONSENT CARD

Kidzville Learning Centers

Name of Facilty

Child's Name

Address

Parent's Name

Home Phone

Work Phone

Emergency Contact

Phone

Care Card#

Deffective

Birthday

Child Lives With

Work Phone

Parent's Name

Home Phone

Phone

Allergies

Medications

Parent Agreement

I have received and read the parent handbook and am aware of the policies and procedures of the school. This is a
valid contract between me and Kidzville Learning centres and I agree to abide by the policies of the school. I also
understand that failure to comply by these rules could result into withdrawal of my child from Kidzville Learning
Centers

Full Name of Child:

School Location:

Parent’s Name:

School Representative:

Date:

Parent’s signature:

Our Contacts

REGISTRATION FORM

Immunizations:Please fill the dates or Attach copy of health book

KIDZVILLE LEARNING CENTERS
CONSENT FORMS & CHILDCARE AGREEMENT

CONSENT FORM NATURE WALKS AROUND SCHOOL

CONSENT FORM

EMERGENCY CONSENT CARD

Kidzville Learning Centers

Parent Agreement

Our Contacts

Our Contacts

REGISTRATION FORM

Immunizations:Please fill the dates or Attach copy of health book

KIDZVILLE LEARNING CENTERS CONSENT FORMS & CHILDCARE AGREEMENT

CONSENT FORM NATURE WALKS AROUND SCHOOL

CONSENT FORM

EMERGENCY CONSENT CARD

Kidzville Learning Centers

Parent Agreement

KIDZVILLE LEARNING CENTERS
CONSENT FORMS & CHILDCARE AGREEMENT