Preschool Registration

Enrolment Date

DayMonthYear

Applying for

Other

Child's Name

First NameLast Name

Gender

First Language

Birth Date

DayMonthYear

Full Name

First NameLast Name

Mobile

Area CodePhone Number

E-mail

example@example.com

Full Name

First NameLast Name

Mobile

Area CodePhone Number

E-mail

example@example.com

Please list the people authorized to pick up your child.

Is your child immunized?

Does your child have any allergies?

If yes please list, including any food or drug allergies.

Does your child have any medical conditions? If yes, please state the Condition and medications required.

Has your child been diagnosed with or shown signs of ADHD, autism, or other developmental/ behavioural needs?

Are reports or assessments available?

Full Name

First NameLast Name

Mobile

Area CodePhone Number

Payment Options

By signing below and submitting payment, I confirm that I have read, understood, and agreed to abide by the policies and procedures of Good Beginnings Children’s Centre.

I, the parent/guardian of this child, give authority to the staff of Good Beginnings Preschool to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if the emergency contact person cannot be reached. I authorize first aid, medical assistance, and treatment as may be deemed necessary.

I understand and agree to a full and complete waiver and release of any and all liability on the part of Good Beginnings Preschool in case of accident, illness, or injury during my child's enrollment.

I confirm that all information provided in this form is true, complete, and accurate.

No Refund Clause: I understand and agree that all fees paid to Good Beginnings Children’s Centre are non-refundable, regardless of withdrawal, absence, or dismissal.

Parents/Guardian Full Name and Signature

NameSignature

Good Beginnings Children's Center

Student Information

Mother/Guardian Information

Father/Guardian Information

Other Information

Primary Emergency Contact

Payment Detail