Oakville Tiny Tots Nursery School Registration

2023-2024

Child’s Legal Name: Amanda Marie Allyson Légaré

Preferred Name: Amanda Légaré
Mailing Address:
Physical Address:
Date of Birth:

PARENT/GUARDIAN INFORMATION
Name of Mother/Guardian:
Physical Address:
Home Phone: Cell:
Work Phone: Email:
Occupation:

Name of Father/Guardian:
Physical Address:
Home Phone: Cell:
Work Phone: Email:
Occupation:

Legal Custodian(s): Both Parents ⎕ Mother ⎕ Father ⎕ Guardian ⎕

Is there a Custody or Restraining Order in Place? YES⎕ NO⎕
Details:

ENROLLMENT
⎕Full time – Tuesday/Thursday

⎕Part time – Tuesday ⎕Part time - Thursday

MEDICAL INFORMATION
MB Health Reg. #: PHIN #:
Doctor’s Name: Phone:
Address:
MEDICAL CONT.
Does your child have any allergies or medical conditions? Are they life threatening? Describe:

Are there any cultural/religious/personal requirements or restrictions that would affect medical care? Describe:

Are there any other concerns you would like us to know about?

AUTHORIZED PICKUPS
Name:
Physical Address:
Home Phone: Cell:
Work Phone:
Relationship to child:

Name:
Physical Address:
Home Phone: Cell:
Work Phone:
Relationship to child:

EMERGENCY CONTACTS
Name:
Physical Address:
Home Phone: Cell:
Work Phone:
Relationship to child: Authorized for pickup:

Name:
Physical Address:
Home Phone: Cell:
Work Phone:
Relationship to child: Authorized for pickup:
CHILD’S GROWTH AND DEVELOPMENT Child’s Name:

Has your child had any previous childcare outside of your home? Please Explain

Are there specific things that your child does when he/she plays that may assist us in helping your child be
comfortable in play?

Does your child like a lot of independent play?

Does your child like to play with others?

What things does your child like to do? Does your child have a favourite game or type of play?

Does your child have siblings? Please list their names and ages.

Does your child have any close friends? Please describe.

Do you have any cultural details you would like to share with us that can assist us in understanding your child?

Is your child LEFT or RIGHT handed? Comments

Would you like to share any other information about your child that could help us care for him/her better?
CANCELLATION

In the event of program cancellation, please indicate your preferred method of notification. (Please choose all
that apply)

Text ⎕ Email ⎕ Facebook ⎕ Instagram⎕

I, __________________________________________________, hereby acknowledge that I have read, understood, and agree to

abide by all of the policies contained within the Oakville Tiny Tots Nursery School Parent Policy Manual.

________________________________________________ ____________________________________________
Signature Date
PERMISSIONS
Emergency Medical Attention YES NO Practicum/Student Observations YES NO
Field Trip and Outings YES NO Photos for School Use YES NO
Release Information YES NO Photos for Media YES NO

EMERGENCY MEDICAL ATTENTION

If my child, while in the care of Oakville Tiny Tots staff, requires medical attention due to serious injury, illness or
emergency, I hereby grant permission to the staff to attain whatever emergency measures are deemed necessary.
I also grant the staff permission to administer first aid treatment, if and when necessary. I understand that this
may involve transportation to the hospital or nearest medical clinic, and I agree to cover the cost associated with
this transportation.

FIELD TRIPS AND OUTINGS

I grant permission for my child to accompany Oakville Tiny Tots staff on local field trips or outings within the
Oakville area. For field trips or outings taken outside of the Oakville area, the school will give prior notification
and you will be asked to complete another Permission Form at that time.

RELEASE INFORMATION
I grant permission for Oakville Tiny Tots to release any information or records relating to my child as required by
the school, or to any other professionals that are involved with my child.

PRACTICUM/STUDENT OBSERVATIONS
I grant permission for my child to be observed by students in fields relevant to childcare if these observations are
kept in confidence and used only as a means to fulfill their course requirements. These observations must be
approved by the Director.

PHOTOS FOR SCHOOL

I grant permission for Oakville Tiny Tots staff to take pictures or videos of my child for the school use.

PHOTOS FOR MEDIA

I grant permission for members of the media, at the direction of the Director, to take pictures or videos of my
child and use my child’s name in the context of a news item or report.