KINDERGARTEN REGISTRATION FORM "*" indicates required fields Which School Are You Interested In?* Cochrane Calgary Village Square Do You Require Before/After Care (7:00 am - 6:00 pm)* Yes No Preferred Class*Parent requests will be considered; however, our priority is to create balanced classrooms that provide optimal learning environments.Please make a selectionAM ClassPM ClassChild's InformationChild's Name* First Middle Last Sex* Male Female Prefer not to say Date of Birth*YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920MM123456789101112DD12345678910111213141516171819202122232425262728293031Attach Here One of the following documents: Birth Certificate, Canadian Passport or Alberta Health Card - required by Alberta Education (please send it in .pdf)*Accepted file types: pdf, Max. file size: 12 MB.Max file size is 10MBIs Your Child Born Outside of Canada?* Yes No If your child was born outside of Canada, Alberta Education requires proof of Canadian residency (visa, permanent residence, citizenship docs)Attach Citizenship Status*Max. file size: 12 MB.Max file size is 10MBAddressHome Phone*Primary Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country 1. Parent or Guardian InformationPrimary Contact Name* First Last Relationship To Child* Main Phone*Primary Email Address* Alternative PhonePrimary Address (if different from address in previous section) Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code 2. 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. It should not be the parent/guardian. This person needs to be local and able to pick up your child.Contact Name* First Last Main Phone*Alternative PhoneAddress* Street Address City Relationship To Child Anyone Else Who Has Permission To Pick-Up Your Child From School. Contact OrderFirst Person to Contact* Second Person to Contact* Third Person to Contact 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 Requires In An Emergency (epi-pen, inhaler, etc.) Medications Your Child Takes On A Regular Basis (insulin, inhaler, etc.) Are There Any Areas Of Concern Regarding Your Child's Development? 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. Primary Language Spoken At Home Other Languages Spoken At Home School Policies ConfirmationBy clicking YES I agree with each of these policies which are described in detail in the Parent Handbook. Permission to Screen - I give permission for my child to be screened by the early intervention team.*Foothills Creative Beginnings provides early intervention screening to identify developmental areas in which your child may require additional support such as, speech and language, fine or gross motor and/or regulation. The screening determines if early intervention services may be recommended for your child. Yes No If the need is determined, I give permission for my child to be assessed by the early intervention team.*Qualification for Alberta Education early intervention funding is based on assessment results. Do you give permission for your child to be assessed by an SLP or OT if the results of screening indicate there is a good possibility your child will qualify for early intervention funding? Yes No 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 2) secondary number(s) 3) 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 will be taken to the designated Emergency Evacuation Site. Parents will 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 at school the parent/guardian or emergency contact will be called to pick up the child as soon as possible.* Yes Provision of Health Care: Foothills Creative Beginnings provides first aid care only unless written consent and direction has been received from the child’s parent to provide prescribed medical interventions.* Yes 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. I give permission for my child’s photos to appear in the Seesaw APP which teachers use for newsletters and to share learning stories.* Yes I give permission for my child’s photos to be used inside the school. Yes I give permission for my child’s photos to be used on the Seesaw APP. No – my child’s photos can’t be used inside the school. No - my child’s photos can’t be used on the Seesaw APP Photos Social Media - Sometimes we like to share images on social media,our website and/or marketing materials. Do you give permission for your child's photo to appear on social media, our website and/or marketing materials?* Yes No 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 Signature*Date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f you have any questions or concerns please call 403.300.5543 or email email@example.comNameThis field is for validation purposes and should be left unchanged.