registration .pdf

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Original filename: registration.pdf
Author: Elizabeth

This PDF 1.5 document has been generated by Acrobat PDFMaker 9.0 for Word / Adobe PDF Library 9.0, and has been sent on pdf-archive.com on 18/08/2016 at 05:15, from IP address 205.250.x.x. The current document download page has been viewed 318 times.
File size: 80 KB (2 pages).
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Elizabeth’s Early Learning Centre Registration

Name of Child:

Birth date:

Gender: M F O

Address:

Postal Code:

City:

Guardian Name:

Relationship to child:

Home Phone:
Guardian Name:
Home Phone:

Work Phone:
Relationship to child:
Work Phone:

Siblings and ages:
Healthcare Information
Dentist:

Phone:

Doctor:

Phone:

Care Card Number:
*Please include your child’s immunization record.*
Authorized people to pick up (Emergency pickup):
Name:

Phone:

Name:

Phone:

Name:

Phone

Unauthorized people to pick up:
Name:

Phone

Name:

Phone:

*If there is a court order in place please include current documentation

About Your Child
Favourite foods:
Food dislikes:
Allergies:
Is an epi-pen needed?
Diet concerns and habits:
What does your child enjoy?

Your child’s biggest fears and interests:

What self help skills is your child capable of?(zippers, buttons, toileting, etc)
What skills is your child working on?
Does your child nap, for how long?
How does your child best fall asleep?
Has your child been in previous care before; if so how was the experience?
Anything else that you would like to include?


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