Sunshine Calley Child Care Society

Sunshine Calley Child Care Society

SUNSHINE VALLEY CHILD CARE SOCIETY

978 72ND AVE. – POBOX 435

GRAND FORKS, BC V0H 1H0

Ph: (250) 442–5314

REGISTRATION FORM

Child’s Name:

Date of Birth: Sex: M F

PARENT / GUARDIAN

FemaleName:

(Mother)Mailing Address: ______PostalCode:______

Street Address: City: ______

Home Phone: Work Phone:

EMAIL:______

MaleName:

(Father)Mailing Address:______Postal Code:______

Street Address:

Home Phone: Work Phone:

Person(s) with whom child lives:

Person(s) to call in case of emergency (other than Parent/Guardian)

Name / Relationship:

Home Telephone: Work Telephone:

Name / Relationship:

Home Telephone: Work telephone:

Name / Relationship:

Home Telephone: Work Telephone:

ONLY These person(s) authorized to pick up child

Name: Name:

Name: Name:

It is the enrolling parent’s responsibility to provide the staff or Executive Director with copies of any legal documentation in regards to custody disputes. Otherwise, both parents will be deemed authorized to pick up and drop off their child(ren). Please sign below to state that you accept this policy.

Signature ______

Requested Program / Days of Attendance / Times of Arrival & Departure

Enrollment Date: Withdrawl Date:

Has your child had previous experience away from home? No,

Yes, please explain:

Is there any information we need to be aware of concerning your child (i.e. Home situation, religious or cultural observations, etc.)?

MEDICAL:

Family Doctor: Telephone:

Carecard Number:

(Please provide the staff with a photocopy of your child’s Care Card)

Family Dentist: Telephone:

Please specify details of any health conditions we need to be aware of:

Allergies:

Diet:

Medication:

Hearing:

Vision:

Speech:

Other:

List communicable diseases child has had (i.e. chicken pox, measles…)

______

IMMUNIZATION RECORD

Due to licensing requirements we must have a copy of the updatedimmunization record in-order for your child to attend or

My child does not receive immunizationsSignature:______

PARENTAL INVOLVEMENT

Are there workshops, parent groups or discussion groups etc. you would like to have offered or be informed of which may help you as a parent?

Are there ways in which you would like to become more involved with either the program or SUNSHINE VALLEY CHILD CARE SOCIETY?

Member of the Society

Board Member of the Society

Fundraising

Build/Repair Equipment

Field Trip Transportation

Other

CONTRACT

I agree to cooperate with the general rules of the SUNSHINE VALLEY CHILD CARE SOCIETY. My signature below indicates that I have read and understand the policies and regulations and fees stated in the Parent Handbook provided to me, at the time of registration. I have had any and all questions answered and clarified to my satisfaction. I find the policies acceptable and agree to comply with all the policies and regulations and financial agreements.

(Signature of Parent/Guardian)(Date)

(Signature of Director) (Date)

PERMISSION FORMS

Ages & Stages Questionnaire- Age Appropriate Developmental Screening

My child______may be screened using the ASQ administered by myself or staff at LPC with the results being shared with the parent/guardian.

______

(Signature of Parent/Guardian) (Date)

PERMISSION FORMS

WALKS AND ROUTINE OUTINGS PERMISSION

The children will be regularly provided with the opportunity to participate in daily walks and routine outings in the Grand Forks area

I hereby give my consent for my child ______to participate in routine daily walks and outings with the staff of Little Peoples’ Centre. I understand that all due care and attention will be given.

Date: ______Signature: ______

PHOTOGRAPH PERMISSION

I hereby give my permission for my child ______to be photographed or videotaped while attending Little Peoples’ Centre or on field trips. I am agreeable to the photographs/videotapes being used for publicity or fundraising purposes and in the program.

Date: Signature:

If you do not wish your child photographed or video taped, regardlessof the circumstances, please inform the staff.

All children will be photographed for emergency identification purposes only. These photos will be kept on file in the emergency first aid kit as required by Licensing.

CONSENT FOR EMERGENCY MEDICAL TREATMENT

It is our policy to notify a parent when a child is ill or needs medical attention. If we are unable to contact parents and we need to get immediate help for the child we require your consent to take appropriate action on behalf of your child.

I authorize the staff of Little Peoples’ Centre to summon an ambulance for emergency medical aid should in the opinion of the staff in attendance feel such services are required and I cannot be contacted by phone. If such emergency should arise, I shall be notified as soon as possible. I agree that any cost incurred for such services shall be my sole responsibility.

Date: ______Signature:______

CONSENT FOR SUNSCREEN APPLICATION DURING SUMMER MONTHS

Children are to arrive with sunscreen already applied, staff will encourage and assist children to apply sunscreen as needed provided by the parent or as purchased through the daycare.If you do not wish your child to have sunscreen, regardlessof the circumstances, please inform the staff.

Date: ______Signature: ______

PLEASE HELP THE STAFF GET TO KNOW YOUR CHILD BETTER…

What types of activities does your child enjoy?

INDOORSOUTDOORS

______

Has your child had previous child care experience: Yes____ No _____

  • Has your child been around other children on a regular basis Yes __No____
  • Is your child usually:

Active___ Quiet____ Independent___ Constructive___ Demanding___

  • Does your child have any fears/anxieties that we should be aware of:______
  • Does your family celebrate any Ethnic or Religious Holidays Yes___No____

MEAL TIME SCHEDULES

  • What is a typical daily feeding schedule for your child: (times/bottles/solids)

______

  • List some of your child’s Likes:Dislikes:

______

______

  • Does your child sit on a chair___ Booster seat ______High Chair ______
  • Can they use a spoon Yes____ No ______
  • Is your child a big eater____ a small eater____ a picky eater _____
  • Are there any foods your child cannot eat due to Ethnic/Religious belief? ______

SLEEP PATTERNS

  • What time approximately does your child: Go to bed___ Wakeup___ Have a Nap______
  • Does your child have a special or required sleep time routine:
  • Pacifier___ Bottle__ Special Blanket____ Stuffed Animal____
  • Other(please describe)______

WASHROOM DIAPER PATTERNS

  • Is your child in diapers: Yes ___ No____ Cloth____ or Disposable ____
  • Does your child use a potty chair ___ toilet ring ____ regular toilet ____
  • Does your child use any special words to communicate bathroom needs?

______

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