» Enrollment Form

Please fill out the enrollment form below and submit:

* All fields are mandatory

Type of Child Care Required: Full-timePart-time
Age Group Placement at Time of Enrollment: InfantToddlerPreschool

Child Information

Parent/Guardian Information

Custody Arrangements (if applicable)

Are there custody arrangements pertaining to legal right of access to your child? YesNo
If YES, please provide a copy of the appropriate legal documentation (e.g., court order).

Emergency Contacts

In the event of an emergency, if a parent cannot be reached, the following individual(s) may be contacted. Please list in order of preference.

Authorized to pick-up child
Authorized to pick-up child
Authorized to pick-up child

Pick-Up Authorization

The following additional individuals are authorized to pick up my child (Photo ID will be required to confirm identify before the child will be released):

Additional Emergency Information

Health Information

If your child has had any history of communicable diseases (e.g., chicken pox, measles), please list them below (see Appendix C for common communicable diseases from Health Canada):

Does your child have any medical need(s) that requires additional support (e.g., Diabetes)? YesNo
If yes, an individualized plan for children with medical needs must be developed between the parent and the child care centre prior to the child’s first day of care.

Allergy Information

Does your child have a life-threatening allergy (e.g., anaphylactic to peanuts or bee stings)? YesNo

If yes, an individualized plan for an anaphylactic allergy that includes emergency procedures must be developed between the parent and the child care centre prior to the child’s start date.

Does your child have any allergies that are not life-threatening (food or other substance [e.g., latex])? YesNo

Dietary and Feeding Arrangements

*For children under 12 months, please complete, Appendix A: Supplementary Information for Children Under 12 Months.
Does your child have any special feeding arrangements (e.g., no sippy cups, mashed/pureed food)? YesNo

Does your child have any special dietary requirements or restrictions (e.g., vegetarian, kosher, halal)? YesNo

Sleep Arrangements

*For children under 12 months, please complete, Appendix A: Supplementary Information for Children Under 12 Months.



Does your child have any special sleep requirements (e.g., specific comfort item, soother)? YesNo

Physical Requirements

Does your child use diapers? YesNo
If no, my child:
Uses the washroom independentlyRequires some assistanceRequires full support

Does your child require any additional support or accommodation with respect to physical activity? YesNo

Additional Information