EVKC early learning program 2025

- please note child must be 3 years old and toilet trained to participate

Child's Details

First Name *

Last Name *

Date of Birth *(DD/MM/YYYY)

Start Date(Office Use Only)

End Date(Office Use Only)

Parent Details

parent Name *

Phone - Home

Email *

Phone - Cell *

Address *

Phone - Work

second parent or emergency contact Name *

Phone - Home

Email

Phone - Cell *

Phone - Work

Please list other people who are authorized to pick up your child.

Name

Phone - Cell

Are there specific individuals who are not allowed access to your child? *

YesNo

Please provide details *

Please provide a copy of relevant court orders regarding parental access. Documents can be uploaded or brought in person to the center manager.

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Does your child have any allergies or food sensitivities? *

YesNo

Please list all allergies and sensitivities *

What reaction do they have when exposed to the allergen? *

List any medication they carry for this allergy

Does your child have any medical conditions? *

YesNo

Please provide more details *

session options

2025 sessions ( Jan/Feb/April/May)

$15 session

9am-11am

Open to 3-5 year olds. Child must be toilet trained

To register please select days below. Please pay within 24hrs. Payment is due by e-transfer to elkvalleykidsclub@gmail.com -please use your childs name as reference.

*No refunds*

If this form is saying session full or you are having trouble registering please email Jamie at the above email.

Please select the days you would like your child to attend *

January 17th Dinosaur exploration with STEMFebruary 21st Letter and Alphabet adventureApril 11th Literature and artmay 23rd Body movement and mindfulness

January 17th Dinosaur exploration with STEM *

February 21st Letter and Alphabet adventure *

April 11th Literature and art *

may 23rd Body movement and mindfulness *

Below is the total owing:

I understand that registration isn't complete until both form and payment have been recieved by EVKC and a confirmation email is sent. *

Permissions

I have read the Elk Valley Kids Club parent handbook. I agree to the EVKC guidelines, policies, and procedures outlined in the parent handbook.

I give permission for Elk Valley Kids Club to call an ambulance in an emergency. *

Yes

I give permission for Elk Valley Kids Club to take pictures of my child for use in the classroom, social media, and websites. *

YesNo

Please attach a colour photo of your child for their file. Photos will only be used in the case of an emergency.

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Sign here *

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