Kido Care Enrollment Form

Your name

Your email

Please fill in all areas of the registration form carefully

Please select what program you are registering for. If more than one child, please write this in the message box

Caterpillar 12 mths-2.5 yearsPupa 2.5 - 3.5 years (potty trained)Butterfly 3.5 - 4.5 yearsFirefly 4-6 preparing for Grade 1, learning skills at kindergarten and beyond

Child's Full Name

Address

Date of Birth

Gender

FemaleMale

Mother's Full Name

Occupation

Employer

Cell Number

Personal email

Father's Full Name

Occupation

Employer

Cell Number

Father's Personal email

Starting School Date

What schedule will you need for your child?

Full TimeMonday, Wednesday FridayTuesday and Thursday

Describe your Child

Allergies or food issues

Alberta Health Number

Medical issues or Medications

Prior School or Childcare

Which Parent or Guardian resides with the child?

Older Brothers and Sisters

Contact or Pick up name #1 (if not parents)

(not parents)

Phone

Address

Relationship to the child

Contact or Pick up name #2 (if not parents):

Phone

Address

Relationship to the child

Additional Comments, Information or Instructions

Parent'sFull Name

Parents Initials

Today's Date

Thank you, Gracias

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