PRESCHOOL STUDENT INFORMATION FORM 2019-2020 Child's InformationChild's Name* First Middle Last Sex*MaleFemaleDate of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Home Phone*Primary Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Primary Parent or Guardian InformationPrimary Contact Name* First Last Relationship To ChildMain Phone*Alternative PhonePrimary Email Address* Primary Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Place of Employment/Name of CompanyAddress of Employment Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Business PhoneSecondary Parent or Guardian InformationSecondary Parent / Guardian Name First Last Relationship To Child - Secondary Parent/ GuardianSecondary Parent / Guardian Main PhoneAlternative PhoneSecondary Parent / Guardian Email Address Address (If different from Parent/Guardian 1) Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Place of Employment/Name of CompanySecondary Parent / Guardian Address of Employment Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Secondary Parent / Guardian Business PhoneEmergency 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 Emergency Contact Main Phone*Alternative PhoneEmergency Contact Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Emergency Contact Relationship To ChildAny Other Persons Who Have Your Permission To Take/Pick-Up Your Child From PreschoolChild'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*If not relevant, please write NONEMedications Your Child Would Need In An Emergency (epi-pen, inhaler, etc.)*If not relevant, please write NONEMedications Your Child Takes On A Regular Basis (insulin, inhaler, etc.)*If not relevant, please write NONEAny Areas of Your Child's Development About Which You Have Concerns*If not relevant, please write NONEImmunizationsPlease Check the Immunizations That Your Child Has Received**routine immunizations 2mo – 18 mo*routine immunizations 4-6 yrs.My Child's Immunizations Are Up-To-Date*YesNoFamily InformationFor the teacher to better understand your child.Family Members in household such as parents, grandparents, siblings, nanny, pets, etc.Language(s) spoken at homeSchool 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 preschool each child must have a Student Information form on file. All areas must be completed.*YesDiscipline Policy: Any child disciplinary action taken is reasonable in the circumstances. No form of physical punishment is used. ( see Handbook for details)*YesAttendance Records: The attendance book is a legal document that the parent/caregiver must sign “in” on arrival and “out” upon departure.*YesChild Release Policy: No child will be released to a person other than a parent without authorization.*YesLate 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) home phone 2) parents’ cells 3) work number(s) 4) emergency contact. After one hour we call social services child protection department.*YesEmergency 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.*YesOutdoor Activities Policy: My child may be taken outdoors for supervised activities and neighbourhood walks by FCB staff.*YesIllness 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).*YesProvision 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.*YesClass 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.*YesPhotos 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.*YesWithdrawing from preschool 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.*YesEmergency 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.*YesSignature*Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920CAPTCHAIf you have any questions or concerns please call 403.851.5534
