Fernie School Aged Care Registration Form
No Photos
Medical Notes
Child's Details
First Name
*
Last Name
*
Date of Birth
*
(DD/MM/YYYY)
Gender
*
Male
Female
Hair Colour
*
Eye Colour
*
Height
*
Weight
*
School
*
Grade
*
Current Date
Start Date
(Office Use Only)
End Date
(Office Use Only)
Parent Details
Mother's Name
*
Phone - Home
Father's Name
Phone - Home
Mom's Email
*
Phone - Cell
Dad's Email
Phone - Cell
Address
*
Phone - Work
Address
Phone - Work
Emergency Contacts
Contact #1
Contact #2
Name
*
(In case parents can not be reached)
Name
Phone - Cell
*
Phone - Cell
Contact in an emergency?
*
Yes
No
Contact in an emergency?
Yes
No
Please list other people who are authorized to pick up your child.
Name
Name
Phone - Cell
Phone - Cell
Are there specific individuals who are not allowed access to your child?
*
Yes
No
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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Medical Information
Doctor's Name
*
Phone Number
*
BC Care Card #
*
Immunization Status
*
Immunizations are up to date
Chose not to immunize
Immunization records can be uploaded or brought to the center manager in person
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Does your child have any allergies or food sensitivities?
*
Yes
No
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?
*
Yes
No
Please provide more details
*
I am interested in registering for:
*
After School care
March Break Camp
Summer Camp
No School Fridays
Select all that apply
Permissions
I have read the Fernie School Aged Care parent handbook. I agree to the FSAC guidelines, policies, and procedures outlined in the parent handbook.
I give permission for Fernie School Aged Care to call an ambulance in an emergency.
*
Yes
I give permission for Fernie School Aged Care to take pictures of my child for use in the classroom, social media, and websites.
*
Yes
No
I give permission for Fernie School Aged Care to take my child on field trips, walks, hikes around Fernie
*
Yes
Licencing requires us to have a colour photo on file of your child. Photos can be uploaded now or submitted in person at Fernie School Aged Care.
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