BUSY BEES NURSERY SCHOOL
REGISTRATION FORM
168 KENNEDY ROAD SOUTH, BRAMPTON, ONTARIO L6W 3G6 TEL (905 454-7676
Busybees011@outlook.com
Date:
Child’s Surname: First Name:
Address:
Home Phone Number: Birth Date D/M/Y:
Email address: ___________________________________________.
Parents or Guardians
Mother’s Name: Father’s Name:
Name of Business: Name of Business:
Business Address: Business Address:
Business Phone: Ext Business Phone: Ext
Occupation: Occupation:
Emergency Names (In case of an emergency and the parents cannot be contacted)
Name: Phone: Relation:
Name: Phone: Relation:
Name: Phone: Relation:
Family Doctor: Tel:
Address:
Other Information: Please describe allergies, Communicable diseases (Chickenpox, measles) Special diet, physical and behavioural problems. Special interests or major changes on the family or any other information that might help us to get to know your child better.
Program Required:
Toddler: Preschool: JK/SK:
Teacher’s Name: School:
Time of Arrival: Time of Departure:
Person authorized to pick up child:
Name: Business Phone:
Relationship: Home Phone:
Name: Business Phone:
Relationship: Home Phone:
NOTICE WITH RESPECT TO THE COLLECTION OF PERSONAL INFORMATION
Municipal Freedom of Information and Protection of Privacy Act
Children’s Records in Directly Operated
Personal information is collected under the authority of the Day Nurseries Act, R.S. O. 1990, c.D2s. 3(1), and
R.R.O. Regulation 262. This information will be used to maintain mandatory up-to-date records required by the Day Nurseries
Act. Questions about the collection of this information should be directed to the Centre Supervisor
Consent, Parental Acknowledgement and Release
CONSENT TO MEDICAL TREATMENT
In the event of any illness or injury to my child while my child is in the care of the Centre, I give my consent and authorize staff to administer First Aid to my child in accordance with Centre staff’s First Aid training. If Centre staff are of the opinion that my child requires urgent medical attention, beyond the scope of Centre staff’s First Aid, I give my consent and authorize Centre staff to seek emergency medical care for my child and to transfer care of my child to emergency medical practitioners. Centre staff will make every effort to contact me as soon as possible in the event of any emergency.
Signature _______________________ Date _________________
CONSENT TO RELEASE OF CHILD
I understand that it is my responsibility to advise the Centre supervisor or designate immediately in writing if there are any changes to the emergency contact information contained on my child’s admission form. I give my consent and authorize Centre staff to release my child at any time to any individual listed as an emergency contact on my child’s admission form without any further notice or instructions from me.
Signature _______________________ Date __________________
In the event of an emergency, I give my consent and authorize the Centre supervisor or designate to release my child to an individual who has not been listed as an emergency contact on my child’s admission form. Where written authorization is not possible then the Centre supervisor or designate would accept the name and verbal description of the designated emergency caregiver and will verify their identification.
Signature _______________________ Date __________________
CONSENTS
Community Excursions: I give my consent for my child to participate in neighbourhood excursions under teacher supervision. Yes/No Initial ____
Sunscreen: I give my consent for Centre staff to apply sunscreen, supplied by myself, onto my child. Yes/No Initial ____
Lotions: I give my consent for Centre staff to apply non- medicated creams or lotions supplied by myself onto my child. Yes/No Initial ____
Child’s work: I give my consent to Busy Bees Nursery School to include my child’s work on their website, displays, newsletters, brochures, communications, videos, newspaper articles or any other form or medium which may be released to the public for the purpose of promoting Regional Child Care programs or any other similar purpose.
Yes/No Initial ____
Audio and Visual Recordings/Photographs of Child: I give my consent to photographs and other audio and visual recordings being taken of my child in the Centre’s care and I further consent and give my permission to Busy Bees to use, display, publish and distribute photos and recordings:
- via the Busy Bees website, display, newsletters, brochures, communications, videos, newspaper articles, or any other form or medium which may be released to the public for the purpose of promoting Busy Bees Childcare programs or for any similar purpose. Yes/No Initial___________________
- for the purpose of classroom activities Yes/No Initial ____
- for the purpose of classroom activities including class/group photos and photos for memory books etc., which may be distributed to other families at the Centre. Yes/No Initial ____
- for administrative and safety purposes such as updating the child’s file, photographing the children prior to off-site excursions etc.
Yes/No Initial _____
If my child becomes ill at the Centre, I will be notified. If requested, I understand and agree that it is my responsibility to pick up my child or arrange for an emergency contact person immediately. I understand and agree that if my child is not well enough to participate in all components of the program, including outdoor play, then I am responsible for arranging alternate childcare. Initial ____
- Parents/Guardians are encouraged to administer medication at home whenever possible. If Centre staff agrees to administer medication at the Centre, a Medication Authorization form must be completed prior to administration of the medication.
Initial ____
- I understand that for health and safety purposes, the Centre does not permit children or parents to bring food into the Centre. I agree that I will not bring, and I will not allow my child to bring food into the Centre. I will also ensure that my child’s clothing and backpack does
not contain any food items or medication.
Initial ____
- I acknowledge that reasonable efforts have been taken to provide an allergen free environment at the Centre; however, I understand the Centre cannot guarantee an environment free of all allergens. I acknowledge that my child may inadvertently come into contact with a substance that s/he may be allergic to and that such contact may result in an allergic reaction. I understand that there are certain risks of allergen contact in a childcare setting.
Initial ____
WITHDRAWAL
We require a MINIMUM OF TWO WEEKS WRITTEN NOTICE OF WITHDRAWAL. The deposit paid at the time of registration will be used as the fees for these last two weeks. If a child is withdrawn without the two weeks’ notice, the deposit will be forfeited.
Signature: _________________________Date__________________
TERMINATION OF SERVICES
At the sole discretion of Busy Bees Nursery School Inc., the parent(s) may be asked to withdraw their child/children from the program. A two-week Written notice period will be given to the parent/s to make alternate arrangements. If the parent/s wishes to withdraw the child /children during the two-week notice period, they may.
Signature: ___________________________Date______________
Code of Conduct
We realize that working with different personalities, temperament and beliefs can sometimes have its challenges. We ask that you direct any concerns regarding children, staff, parents, students, volunteer and consultants work within the centre, directly to the Supervisor/Designate, in person, by e-mail or in a written format. Please allow the Supervisor time to resolve all concerns and issues. All concerns will be investigated and researched in order to achieve the best result possible, including advice from the Ministry of Education. Respect must always be maintained therefore, we ask that you do not resort to any harsh deliberate, physical or degrading measures directed toward any of the children, staff, students, volunteer, parent or consultant within or/on the property of the Child Care Centre. Any verbal, physical or punitive display of action resulting in an altercation between any single or group of individuals will not be tolerated and will result in, termination of employment, banned access to the centre and an end to your services at Busy Bees Child Care Centre. Contraventions of behaviour for staff, students and volunteers are outlined in the Centre’s Policy Manual.
Signature: _____________________Date_________________
PARENT HANDBOOK
I confirm that the Centre supervisor or designate has reviewed with me the details contained in these sections of the Parent Handbook:
- Arriving at the Centre ____ initial
- Leaving for the day _____ initial
- Giving Medicine _____ initial
- Child Abuse Reporting ____ initial
- Vacation_______Initial
I confirm that I have received and read the Parent Handbook in full. I understand and agree to abide by all of the parent responsibilities and policies outlined in the Parent Handbook as a condition of receiving childcare for my child.
Signature_______________Date_______________________ Initial _____
RELEASE/ WAIVER/ INDEMNITY
In consideration for the provision of child care services, I hereby agree to release, waiver, forever discharge, save harmless and keep indemnified Busy Bees (including its employees, officers, elected officials, volunteers, representatives, agents and all those for whom it is legally responsible) from and against any and all claims, actions, damages, costs, expenses, losses and liabilities, of any kind whatsoever, and howsoever caused, arising from, or in connection with, the provision of child care services, unless same is caused by the sole negligence of Busy Bees.
______________ ___________________________
Date Signature of Parent/Guardian
_______________ ______________________________
Date Signature of Parent/Guardian
______________ ______________________________
Date Signature of witness
____________________________________________________________________________
For Office use only
Registration Fee Received: Amount $_____________Date ___________ Key Deposit: $___________Date__________ two weeks deposit $_____________________ Date_______________.
