Tiny Tot Oakville 2023 2024
Tiny Tot Oakville 2023 2024
Tiny Tot Oakville 2023 2024
2023-2024
PARENT/GUARDIAN INFORMATION
Name of Mother/Guardian:
Physical Address:
Home Phone: Cell:
Work Phone: Email:
Occupation:
Name of Father/Guardian:
Physical Address:
Home Phone: Cell:
Work Phone: Email:
Occupation:
ENROLLMENT
⎕Full time – Tuesday/Thursday
MEDICAL INFORMATION
MB Health Reg. #: PHIN #:
Doctor’s Name: Phone:
Address:
MEDICAL CONT.
Does your child have any allergies or medical conditions? Are they life threatening? Describe:
Are there any cultural/religious/personal requirements or restrictions that would affect medical care? Describe:
Are there any other concerns you would like us to know about?
AUTHORIZED PICKUPS
Name:
Physical Address:
Home Phone: Cell:
Work Phone:
Relationship to child:
Name:
Physical Address:
Home Phone: Cell:
Work Phone:
Relationship to child:
EMERGENCY CONTACTS
Name:
Physical Address:
Home Phone: Cell:
Work Phone:
Relationship to child: Authorized for pickup:
Name:
Physical Address:
Home Phone: Cell:
Work Phone:
Relationship to child: Authorized for pickup:
CHILD’S GROWTH AND DEVELOPMENT Child’s Name:
Has your child had any previous childcare outside of your home? Please Explain
Are there specific things that your child does when he/she plays that may assist us in helping your child be
comfortable in play?
What things does your child like to do? Does your child have a favourite game or type of play?
Does your child have siblings? Please list their names and ages.
Do you have any cultural details you would like to share with us that can assist us in understanding your child?
Would you like to share any other information about your child that could help us care for him/her better?
CANCELLATION
In the event of program cancellation, please indicate your preferred method of notification. (Please choose all
that apply)
________________________________________________ ____________________________________________
Signature Date
PERMISSIONS
Emergency Medical Attention YES NO Practicum/Student Observations YES NO
Field Trip and Outings YES NO Photos for School Use YES NO
Release Information YES NO Photos for Media YES NO
RELEASE INFORMATION
I grant permission for Oakville Tiny Tots to release any information or records relating to my child as required by
the school, or to any other professionals that are involved with my child.
PRACTICUM/STUDENT OBSERVATIONS
I grant permission for my child to be observed by students in fields relevant to childcare if these observations are
kept in confidence and used only as a means to fulfill their course requirements. These observations must be
approved by the Director.