Parkview Preschool Edmonton - Register for Kindercare

Kindercare Registration

Email Address(*)

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Registering For:(*)

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Name of Child:(*)

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Child's Birthdate:(*)

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What school is your child attending? Note: Transportation from Parkview Elementary is provided.

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Mothers Name:(*)

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Fathers Name:(*)

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Address:(*)

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Child's Address if different from above:

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Mom Cell Number:(*)

123-456-7890

Mom Work Number:

123-456-7890

Home Phone Number:(*)

123-456-7890

Dad Cell Number:(*)

123-456-7890

Dad Work Number:

123-456-7890

Child resides with (check applicable box(s)):(*)

MotherFatherGuardianShared Custody

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Childs Gender:(*)

MaleFemale

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Community League you live in:

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Membership Number:

Valid Membership Required

Care Giver (if applicable):

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Care Giver Cell Number:

123-456-7890

Medical Information

Doctor's Name: (*)

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Phone Number:(*)

123-456-7890

Are your child's immunizations up to date?

YesNo Invalid Input

List childhood diseases to date:

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Please list any allergies or medical information that the Kindercare staff should be aware of:

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*** IN CASE OF EMERGENCY, IF PARENT OR GUARDIAN IS NOT AVAILABLE, PLEASE CONTACT: ***

Name:(*)

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Relationship:(*)

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Phone Number:(*)

123-456-7890

Cell Number:(*)

123-456-7890

Address:(*)

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Please include postal code.

Are you human?(*)

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