Registration Form Name of Child Preferred name. Birth Date: Age as of Sept.30, 2015 Gender (MF), Parent/Guardian Name(s): Street Address: Mailing Address (please include postal code): Home Phone: Work Phone: Email address: Mom's Ce Dad's Cell: Alternate Contact and Phone: 1. What is your preferred time? Please indicate your 1st and 2nd choices: ‘© Twice per week (4 yr olds): Tue/Thu am___Tue/Thu pm © Once per week (3 or 4 yr olds): Wed pm ‘© Once per week (3 yr olds): Wed am 2. Name of child you would like to be in the same class with (optional — please note not all requests can be granted): 3. May we include your name and phone number on the student list? Yes or No 4. Allergies, health or other concerns: 5. Doctor’s name and phone number: 6. Saskatchewan Health Number (for medical emergencies) 7. Is your child's tuition to be paid from an outside source such as Fai Early Entrance programs? Yes. No (To protect your privacy the Administrator will contact you for your information.) ly Services, or OFFICE USE ONLY" Day(s) Chis attending AMI PM $30 Regisiration Fee Collected Monthly postdated cheques Full year payment Half a year payment Sept-Dec Half a year payment Jan-May Other oooooo