Preschool Student Information Form – Foothills Creative Beginnings

2208, 120 - 5th Avenue West, Cochrane, AB 403-851-5534 Email Us

PRESCHOOL STUDENT INFORMATION FORM 2018-2019

Child's Information
Child's Name*
First Middle Last
Sex*
- Male
- Female
Date of Birth*
Home Phone*
Primary Address*
Street Address City Province Postal Code
Primary Parent or Guardian Information
Primary Contact Name*
First Last
Relationship To Child
Main Phone*
Alternative Phone
Primary Email Address*
Primary Address*
Street Address City Province Postal Code
Place of Employment/Name of Company
Address of Employment
Street Address City Province Postal Code
Business Phone
Secondary Parent or Guardian Information
Parent / Guardian Name
First Last
Relationship To Child
Main Phone
Alternative Phone
Email Address
Address (If different from Parent/Guardian 1)
Street Address City Province Postal Code
Place of Employment/Name of Company
Address of Employment
Street Address City Province Postal Code
Business Phone
Emergency Contact Information
This 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 Phone
Address*
Street Address City Province Postal Code
Relationship To Child
Any Other Persons Who Have Your Permission To Take/Pick-Up Your Child From Preschool
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
Immunizations
Please 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*
- Yes
- No
Family Information
For 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 Confirmation
By 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.*
- 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) home phone 2) parents’ cells 3) work 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
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 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.*
- Yes
Emergency Medical Authorization
I 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*
If you have any questions or concerns please call 403.851.5534