Daycare Registration Form - Just For Fun Party Centre

Choose any time between 7am and 6pm

Monday

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Tuesday

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Wednesday

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Thursday

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Friday

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Name *

First

Last

Date of Birth *//

MM/DD/YYYY

Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Language(s) Spoken at Home

Name *

First

Last

Relationship to Child *

Primary Phone Number *

Alternate Phone Number

Email *

Address same as child? *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Custody Arrangements (if applicable)

Are there custody arrangements pertaining to legal right of access to your child?

If YES, please provide a copy of the appropriate legal documentation (e.g., court order). *

Click or drag a file to this area to upload.

Name (s) of custodial parent(s): *

First

Last

Name (s) of individuals prohibited from accessing/picking up your child:

First

Last

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

Name *

First

Last

Relationship to Child *

Phone *

Alternate Phone

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Authorized to pick-up child? *

Add another Emergency Contact

Name *

First

Last

Relationship to Child *

Phone *

Alternate Phone

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Authorized to pick-up child? *

Additional Emergency Information

Health Information

Health Canada Infectious Diseases: https://www.canada.ca/en/public-health/services/infectious-diseases.html

Does your child have a medical need that requires additional support (e.g. Diabetes)? *

If yes, an individualized plan for children with medical needs must be developed between the parent and the home childcare agency prior to the child’s first day of care.

Immunization Records

Click or drag a file to this area to upload.

Please provide a copy of your child’s immunization record (e.g., yellow card) to the agency prior to your child’s first day of care. If you do not have an immunization record, please fill in the chart below.

If you have chosen not to immunize your child, a Statement of Medical Exemption form or a Statement of Conscious or Religious Belief form must be completed and provided to the agency. These forms are available on the Ministry of Education’s website.

Ontario’s Publicly Funded Immunization Schedule - http://www.health.gov.on.ca/en/pro/programs/immunization/schedule.as

Allergy Information

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

If yes, an individualized plan for an anaphylactic allergy that includes emergency procedures must be developed between the parent and the home childcare agency 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))? *

If yes, please provide relevant details, including what your child is allergic to, symptoms of a reaction and treatment. *

Sleep Arrangements

How many naps does your child have each day?

At what times does your child nap?

How long does your child usually nap?

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

If yes, please provide relevant below. *

Physical Requirements

Is your child in diapers? *

If no, my child:

Uses the washroom independently
Requires assistance
Requires full support

Please provide details, if necessary.

Does your child require any additional support with respect to physical activity? *

If yes, please provide relevant details. *

Please indicate any additional information which is relevant to the care of your child (e.g., prone to colds, frequent shoulder dislocation, etc.)

Parent Name *

First

Last

Signature of Parent *

By typing your full name above you agree to the terms and conditions.

Date Signed *//

MM/DD/YYYY

Note: ‘Parent’ is defined as a person having lawful custody of a child or person who has demonstrated a settled intention to treat a child as a child of his or her family, and includes legal guardians.

Authorization for Non-Prescription Skin Products

Child’s Full Legal Name

First

Last

Date of Birth

The following non-prescriptionitems may be applied to my child in accordance with the manufacturer’s instructions on the original container (please check off)

Sunscreen
Diaper Creams/Ointment
Lip balm
Hand sanitizers
Insect repellent
Lotions

Just For Kids has agreed to provide:

Note: Consider adding the brand name of the non-prescription items for transparency.

Parent has agreed to provide:

Note: Consider adding the brand name of the non-prescription items for transparency.

Signature of Parent *

By typing your full name above you agree to the terms and conditions.

Date

MM/DD/YYYY