KINDERGARTEN STUDENT INFORMATION FORM Child's InformationChild's Name* First Middle Last Sex* Male Female Other Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Attach Birth Certificate*Max. file size: 12 MB.Max file size is 10MBHome Phone*Primary Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Primary Parent or Guardian InformationPrimary Contact Name* First Last Relationship To Child* Main Phone*Primary Email Address* Alternative PhonePrimary Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Secondary Parent or Guardian InformationParent / Guardian Name First Last Relationship To Child Main PhoneEmail Address Alternative PhoneAddress (If different from Parent/Guardian 1) Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Emergency Contact InformationThis is a person who could come to pick up your child in the case of illness or emergency if the school is unable to reach the parent.Parent / Guardian Name* First Last Main Phone*Alternative PhoneAddress* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Relationship To Child Any Other Persons Who Have Your Permission To Take/Pick-Up Your Child From Kindergarten Child's Medical Information***FCB will not administer medication without written authorization from the legal guardian. A special form is required.Alberta Health Care Number (FOIP) Allergies or Diet Restrictions Medications Your Child Would Need In An Emergency (epi-pen, inhaler, etc.) Medications Your Child Takes On A Regular Basis (insulin, inhaler, etc.) Any Areas of Your Child's Development About Which You Have Concerns ImmunizationsMy Child's Immunizations Are Up-To-Date* Yes No Family InformationFor the teacher to better understand your child.Family Members in household such as parents, grandparents, siblings, nanny, pets, etc. Language(s) spoken at home School Policies ConfirmationBy clicking YES I agree with each of these policies which are described in detail in the Parent Handbook. Student Information and Health form: To attend kindergarten each child must have a Student Information form on file. All areas must be completed.* Yes Discipline Policy: Any child disciplinary action taken is reasonable in the circumstances. No form of physical punishment is used. ( see Handbook for details)* Yes Attendance Records: The attendance book is a legal document that the parent/caregiver must sign “in” on arrival and “out” upon departure.* Yes Child Release Policy: No child will be released to a person other than a parent without authorization.* Yes Late Pick-up Policy: If you or an authorized person has not picked up your child within 15 minutes of the end of class, we will call:1) parents’ cells 3) secondary number(s) 4) emergency contact. After one hour we call social services child protection department.* Yes Emergency Evacuation Procedure: Should there be a situation where the school must be evacuated the children would be taken to the Boys and Girls Club, 111 – 5th Avenue. The parents would be contacted to pick up their children as soon as possible.* Yes Outdoor Activities Policy: My child may be taken outdoors for supervised activities and neighbourhood walks by FCB staff.* Yes Illness Policy: If a child exhibits signs or symptoms of illness while at Foothills Creative Beginnings program the parent/guardian or emergency contact will be called to pick up the child immediately (within 2 hours).* Yes Provision of Health Care: Foothills Creative Beginnings will provide first aid care only unless written consent and direction has been received from the child’s parent to provide prescribed medical interventions.* Yes Class Lists Policy: I give permission for my child’s and parent names, addresses, phone numbers to be listed on the class lists which are distributed to class members.* Yes No Photos Policy: I give permission for the staff of FCB to take photos of my child, as documentation of my child’s discoveries and achievements and will allow the display of these photos within the classroom areas.* Yes Withdrawing from Kindergarten Policy: One month’s notice is required if a child is to be withdrawn. When children are on holiday or have not attended preschool for any other reason, tuition is payable to reserve the child’s place during the absence.* Yes Emergency Medical AuthorizationI authorize the staff of Foothills Creative Beginnings to administer first aid as required and to have my child transported by ambulance for medical treatment in an emergency. The parent/guardian would be contacted immediately. Parents are responsible for the cost of any medical assistance such as ambulance.* Yes Preferred Class*Please make a selectionAM ClassPM ClassSignature*Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920CAPTCHAIf you have any questions or concerns please call 403.851.5534NameThis field is for validation purposes and should be left unchanged.
