King's Kids Preschool Registration Form

King's Kids Preschool Registration Form
I would like to register my child for:*

3 year old class (Tuesdays & Thursdays from 9:30am-12pm)4 year old class (Mondays, Wednesdays & Fridays from 9:30am -12pm)

Student Information
Child's Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Phone *
Please enter a valid phone number.
Mailing & Physical Address (we do need BOTH the mailing and the physical addresses please)*

Mailing Address

Street Address

CityState / Province

Postal / Zip Code
Gender

FemaleMale
Alberta Health Care # blanks*.
Does your child have any allergies we should be aware of?*

YesNo
If yes, please provide details:
Does your child require medication / epi-pen for the above mentioned allergies? * If yes, an Individual Record of Medication/Herbal Remedy Administration Form needs to be filled out (see church office staff for form). Epi-pens & inhalers MUST be left with your child's teacher each day your child is in attendance.*

YesNo
Are there any developmental delays, medical or behavioral situations we should be aware of?*

YesNo
If yes, please explain: