Program Registration 2020 – Tiny Toes Day Care

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Program Registration 2020 – Tiny Toes Day Care

Program Registration 2021 -Tiny Toes Day Care

Child's Information
Child's Name*
First Last
Child's Home Address*
Child's Home Address
Child's Birthdate*
Date Format: MM slash DD slash YYYY

Child's Birthdate
*
Gender
Mother / Guardian Contact Information
Mother / Guardian*
Name Cell#
Mother / Guardian Address*
Address
Mother / Guardian Email*

Email
Father / Guardian Contact Information
Father / Guardian*
Name Cell# Work#
Father / Guardian Address*
Address
Father / Guardian Email*

Email
Parent/Guardian with legal custody*
*If there is a custody order please include a copy with your registration
Emergency Contact Information
Emergency Contact (Cannot be Mother or Father, must have a local address)
Emergency Contact Name*
Name Cell# Work#
Emergency Contact Address*
Emergency Contact Address
List of people allowed to Pick up your child
Medication Required (epi pen, puffer, etc.)?*
- Yes
- No
Medication Required Type
Medication Required Type
Relevant Health information (Medical Condition (s))?*
- Yes
- No
List Medical Condition(s):
List Medical Condition(s):
Does your child have any pre-existing conditions that may present as influenza like symptoms? Ex: Allergies, chronic cough, etc*
- Yes
- No
List pre-existing Condition(s):
List pre-existing Condition(s):
Is Your Child Immunized?*
- Yes
- No
Allergies?*
- Yes
- No
Allergies please list
Inclusive care needed? (If Yes, interview required)*
- Yes
- No
Please describe child's inclusive care condition/needs
Dietary restrictions please List
Please list any other relevant Information:
Please list any other relevant Information:
Cultural Background:*
Cultural Background:
I agree:*
- Select All
- 1. I have been advised of the program activities, and I am aware that certain risks are inherent in my child's participation in the program activities.
- 2. I understand that every care and attention will be given to the health and comfort of the participant and that BGC Fort McMurray Board and Staff cannot be held liable for any injuries sustained.
- 3. I hereby give permission that my child listed above may be given emergency first aid treatment by a staff member from this program deemed necessary. I also give consent for my child to be transported by car or ambulance to an emergency center for treatment and agree to hold this program and its employees harmless. Any costs associated with medical care and treatment (including ambulance fees) will be the responsibility of the parent/guardian.
- 4. If I cannot be contacted immediately, medical or surgical treatment can be administered to my child in the case of an accident or emergency, as prescribed by a treating physician, and hold this program and its employees harmless.
- 5. *Any costs associated with medical care and treatment (including ambulance fees) will be the responsibility of the parent/guardian.
- 6. It shall be the discretion of the leader of the activity as to what steps must be taken for the welfare and safety of the participant. Each program is a group living experience; members of each group are expected to participate fully in the program and to behave in the appropriate manner. Each child is given as much care and attention as possible, but the parents and the children must note that continuous disruptive behaviour, which affects the enjoyment and safety of others, may result in the child being sent home.
- 7. I, the Parent/Guardian of the child, do hereby agree to give BGC Fort McMurray permission to take pictures of my child while participating in the various programs and activities at the BGC Fort McMurray for the purpose of advertisement, promotion and publicity campaigns. This might include posting to the internet.
- 8. I hereby permit that my child listed above can participate in spontaneous field trips to the local park or walks in the neighbourhood that would involve taking the child outside of the child care program premises for their benefit in attendance at this program. If major field trips (involving transportation in a vehicle) are planned, a separate permission form will be provided in advance for parents/guardians to sign. This form will include the date, transportation and supervision arrangements of the activity.
- 9. I give permission to release my child's information to the Alberta Child and Family Services Licensing Officer for quality and licensing purposes.
- 10. I understand that if my child displays ANY symptoms of illness, they will be isolated from the other children, and I must arrange pickup within 30 minutes of being contacted.
- 11. I have read the "Reopening Agreement" and am familiar with the current COVID-19 regulations and guidelines. I understand that failure to comply with these regulations may result in my family's dismissal from the childcare centre.
- 12. I fully understand all of the information in this form, and I have discussed this carefully with my child. NOTE: NO REFUNDS WILL BE GIVEN.
- 13. I understand that my child is to be picked up by 6:00 pm at the latest each day. (Your child must be signed out every day). If I do not adhere to this, I understand that it will result in a $1.00 per minute charge for each minute that I am late. I fully understand all the information in this form, and I have discussed this carefully with my child. NOTE: NO REFUNDS WILL BE GIVEN.
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Program Registration 2020 – Tiny Toes Day Care

Program Registration 2021 -Tiny Toes Day Care

Child's Information

Mother / Guardian Contact Information

Father / Guardian Contact Information

Emergency Contact Information