* All fields are mandatory
Type of Child Care Required: Full-timePart-time Age Group Placement at Time of Enrollment: InfantToddlerPreschool
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).
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.
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):
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.
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
*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
*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
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