Registration Form

Year of Application

AM PRESCHOOL PROGRAM (Born 2021)

Monday/Wednesday AM Preschool (8:10-11:10)
Monday/Wednesday/Friday AM Preschool (8:10-11:10)
Tuesday/Thursday AM Preschool (8:10-11:10)
Monday-Friday AM Preschool (8:10-11:10)

AM JK Program (Born 2020)

ALL AM JK PROGRAMS ARE FULL. PLEASE CONTACT FOR MORE INFORMATION

PM PRESCHOOL PROGRAM (Born 2021)

Monday/Wednesday/Friday PM Preschool (12:20-3:20) **2 SPOTS LEFT**

PM JK Program (Born 2020)

ALL PM JK PROGRAMS ARE FULL. PLEASE CONTACT FOR MORE INFORMATION

PM Kindergarten Program (Born 2019)

THIS PROGRAM IS FULL. PLEASE CONTACT FOR MORE INFORMATION

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