Montessori OSC Registration Form Requested Start Date* Child's Name* First Last Child's Address*Child's Date of Birth* Child's Gender*MaleFemaleMother's InformationMother's Name First Last Is the mother's address same as child's address?YesNoMother's AddressMother's address if different from child's address.Mother's Home PhoneMother's Cell PhoneMother's Email Mother's Place of WorkMother's Business PhoneMother's Work HoursFather's InformationFather's Name First Last Is the father's address same as child's address?YesNoFather's AddressFather's address if different from child's address.Father's Home PhoneFather's Cell PhoneFather's Email Father's Place of WorkFather's Business PhoneFather's Work HoursChild's Emergency InformationChild's PhysicianChild's Physician's PhoneChild's Alberta Health Care Number*Child's AllergiesPlease provide TWO Emergency Contact People (excluding Parents) to whom child may be released.Emergency Contact #1 Name*Emergency Contact #1 Address*Emergency Contact #1 Phone*Emergency Contact #2 NameEmergency Contact #2 AddressEmergency Contact #2 PhoneDaily Drop-off Time : HH MM AM PM Daily Pick-up Time : HH MM AM PM Child's Health History and Relevant InformationImmunizations Up to Date?*YesNoReaction to stressAllergies / food restrictions?Medical issuesMedications given regularlyDisorders / Diseases / Health IssuesPrior Child Care Experience?YesNoIf yes to prior child care experience, please listWho has custody of the child?If applicable, please provide a copy of the custody papers, please.Age(s) of siblingsParent Method of DisciplineHow did you hear of our centre?*"Get to know you" InformationOur staff like to form personal relationships with each child. By filling out this information, the teacher can prepare for his/her arrival in the classroom. Thank you!Child's CultureOther languages spokenFamily Cultural CelebrationsFavorite Cultural FoodsWill you share cultural traditions / skills with us?YesNoSpecial Skills / TalentsFavorite Food / SnacksFavorite Toy / ActivitiesFear / AnxietiesWays your child expresses anger / frustrationHow do you comfort your child?Unique family situation that we should be aware ofOther information that your child's teacher needs to be aware ofAge Appropriate Developmental Goal*We thank you for choosing our Centre for your child care needs. In order to help with your child’s optimal development, we would like you to share one age appropriate goal that you would like us to help your child achieve. We want your child to SUCCEED!