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Child’s Info

Child’s Full Legal Name(*)

Please type your full name.

Child’s Preferred Name(*)

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Child’s Date of Birth (*)

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Child Lives With(*)

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Gender(*)

Please type your full name.

Preferred Start Date (*)

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Hours of Attendance

Drop Off Time(*)

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Pick Up Time(*)

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Parent/Guardian Info

Parent/Guardian 1

Full Name(*)

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Relationship to Child(*)

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Home Address(*)

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Email Address(*)

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Primary Contact #(*)

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Secondary Contact #

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Place of Work(*)

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Occupation(*)

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Parent/Guardian 2

Full Name

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Relationship to Child

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Home Address

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Email Address

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Primary Contact #

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Secondary Contact #

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Place of Work

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Occupation

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Emergency Contact

Emergency contacts will only be contacted if parents/guardians are unavailable, parents/guardians will be contacted FIRST. Please note that you are authorizing these persons to pick up your child at anytime and on any day, without the centre requiring your prior notice!

Anyone coming for child pick up MUST have proper identification (government issued photo ID) or the Kittens’ Mittens Child Care will NOT release the child.

1^st Emergency Contact

Full Name

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Relationship to Child

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Home Address

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Primary Contact #

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Secondary Contact #

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2^st Emergency Contact

Full Name

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Relationship to Child

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Home Address

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Primary Contact #

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Secondary Contact #

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Medical Info

Child’s Alberta Health Card Number(*)

Please type child’s Alberta Health Card Number.

Family Physician Name(*)

Please type your Physician Name.

Family Physician Phone #(*)

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Any Known Allergies/Sensitivities

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Typical Symptoms/Reactions

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Dietary Food Restrictions

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Medical/Emotional Conditions

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Any Medication Given Regularly

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Up to date immunizations?(*)

Yes

No

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*If yes, please provide copy of your child's immunization record. (image files only)

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We want to discover more about your child!

Your child’s favourite

Toy/Stuffie

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Animal

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Colour

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Song/Story

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Activities

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Do you have pets?

Yes

No

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What are their names?

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Is your child scared of something?

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What is your child’s the most and the least favourite food?

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How long does your child nap for?

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How does your child like to fall asleep?

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Does your child have any brothers or sisters? What are their names?

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Language/s spoken, written or heard at home

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Special celebrations your family participates in

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Anything else you think will help us to get to know your child

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How did you hear about us?

Provide other sources

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Recaptcha(*)

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Register Now

Child’s Info

Parent/Guardian Info

Parent/Guardian 1

Parent/Guardian 2

Emergency Contact

1^st Emergency Contact

2^st Emergency Contact

Medical Info

We want to discover more about your child!

Your child’s favourite

How did you hear about us?

Quick Links

Programs

Newsletter

Search

Register Now

Child’s Info

Parent/Guardian Info

Parent/Guardian 1

Parent/Guardian 2

Emergency Contact

1st Emergency Contact

2st Emergency Contact

Medical Info

We want to discover more about your child!

Your child’s favourite

How did you hear about us?

Quick Links

Programs

Newsletter

Search

1^st Emergency Contact

2^st Emergency Contact