Preschool Student Information Form

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

Secondary Parent / Guardian Name

First Last

Relationship To Child - Secondary Parent/ Guardian

Secondary Parent / Guardian Main Phone

Alternative Phone

Secondary Parent / Guardian Email Address

Address (If different from Parent/Guardian 1)

Street Address City Province Postal Code

Place of Employment/Name of Company

Secondary Parent / Guardian Address of Employment

Street Address City Province Postal Code

Secondary Parent / Guardian 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

Emergency Contact Main Phone*

Alternative Phone

Emergency Contact Address*

Street Address City Province Postal Code

Emergency Contact 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*

If not relevant, please write NONE

Medications Your Child Would Need In An Emergency (epi-pen, inhaler, etc.)*

If not relevant, please write NONE

Medications Your Child Takes On A Regular Basis (insulin, inhaler, etc.)*

If not relevant, please write NONE

Any Areas of Your Child's Development About Which You Have Concerns*

If not relevant, please write NONE

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*

CAPTCHA

Child's Information

Primary Parent or Guardian Information

Secondary Parent or Guardian Information

Emergency Contact Information

Child's Medical Information

Immunizations

Family Information

School Policies Confirmation

Emergency Medical Authorization

If you have any questions or concerns please call 403.851.5534