Registration Form

Year of Application

AM PRESCHOOL PROGRAM (Born 2022)

Monday/Wednesday AM
Tuesday/Thursday AM
Monday/Wednesday/Friday AM
Monday-Friday AM

8:10am - 11:10am

AM JK Program (Born 2021)

Tuesday/Thursday AM
Monday/Wednesday/Friday AM
Monday-Friday AM

8:20am - 11:20am

PM PRESCHOOL PROGRAM (Born 2022)

Tuesday/Thursday PM
Monday/Wednesday/Friday PM
Monday-Friday PM

12:20pm-3:20pm

PM JK Program (Born 2021)

Tuesday/Thursday PM
Monday/Wednesday/Friday PM
Monday-Friday PM

12:20pm-3:20pm

PM Kindergarten Program (Born 2020)

Monday-Friday PM

12:20pm-3:20pm *NOTE: This is a 5-day program*

Child Information

Childs Full Name*

First Middle Last

Gender*

Male
Female
Not Specified

Birthday*

Age*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Language(s) Spoken*

Toilet Trained*

Yes
No

If not toilet trained, please explain

Child's Alberta Health Care Number*

Is your Child affiliated with I'm For Kids Team or any other programs? If yes, please explain (Name of program, reason for being there)*

If your child attends a day home/babysitters ect. during the day, please provide contact information

Parent/Guardian Information

Mother's Name/Guardian's Name*

Mother's (Guardians) Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone*

Cell Phone

Email*

Enter Email Confirm Email

Place of Work*

Work Contact Number*

Father's/Guardian's Name*

Father's (Guardians) Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone*

Cell Phone

Email*

Enter Email Confirm Email

Place of Work*

Work Contact Number*

Others living in the home

Name, Age and Relationship to Child

Emergency Contact Information

**THIS CANNOT BE THE MOTHER OR THE FATHER and must be able to pick up your child incase of an emergency**

Name*

First Last

Home Phone*

Cell Phone

Relationship to Child*

Name*

First Last

Home Phone*

Cell Phone

Relationship to Child*

Medical Information

Allergies*

Please be specific including signs and symptoms

Does your child use an Epi Pen*

Yes
No

Does your child require a Puffer*

Yes
No

Medication*

Please provide a list of all medication including dosage and when administered

Is your Child's Immunizations up to date*

Yes
No

If no, please explain

Additional Health Information

Registration Fee

A $50.00 Non refundable fee is due at the time of submission. In your E-Transfer please put your FIRST and LAST name on the transfer

Method of Payment*

E-Transfer: Please make questions WHAT CITY ARE WE LOCATED IN and answer Airdrie

E-Trasnfer to: munchkinacademypreschool@hotmail.com ***PLEASE INCLUDE CHILDS NAME IN ETRANSFER DESCRIPTION***

Registration Package

Child Information

Parent/Guardian Information

Emergency Contact Information

Medical Information

Registration Fee