Castledowns Childcare - OSC Registration

Review Dates

CASTLEDOWNS CHILDCARE OSC

Child Intake Form OSC

Please note that Castledowns Childcare OSC is licensed for children attending school in grades 1 to 6.

Child's Name

Nickname

Birthday Day

Month

Year

Age

Child's Address

Postal Code

Alberta Health Care Number

Family Physician

Address

Phone No.

Subsidy?

Yes No

If yes, please refer to "Subsidy Agreement" form.

Approximate time child will be dropped off

and picked up

Start Date

Name of persons having legal custody:

1. Name

Address

Phone No.

2. Name

Address

Phone No.

Persons you expressly do not want your child released to

Copy of legal custody and/or Restraint order is required if applicable.

Yes No

Parent/Guardian Employment Info:

Parent Name

Place of Work

Work Phone #

Home Phone #

Parent Name

Place of Work

Work Phone #

Home Phone #

Please list the names and ages of any other children in the family

Emergency contact persons your child may be released to: (Minimum 3 required)

1. Name

Address

Relation to child

Phone #: Home

Work

2. Name

Address

Relation to child

Phone #: Home

Work

3. Name

Address

Relation to child

Phone #: Home

Work

Does your child have any allergies?

Y N

If so, what are they?

Are your child's immunizations up to date?

Y N

Any Medication

OSC Registration Form