Contact Name
*
Parent or Guardian
First Name
Last Name
Contact Email
*
Child's Name
*
First Name
Last Name
My child is a...
*
First Class Preference
*
Please read carefully.
Second Class Preference.
*
Please read carefully. If your first choice is not available.
Subsidy Application
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Indus Preschool Association
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A board of Parent Volunteers runs the Preschool; what Board Member Position(s) would you be interested in:
Would you like to volunteer in the classroom?
Please note you will need a police background check completed for Indus Preschool.
How did you hear about the Indus Preschool?
Child's Name
*
First Name
Last Name
Child's Nickname/Preferred Name:
Gender
*
Date of Birth
*
MM
DD
YYYY
Child's Home Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Parent/Legal Guardian 1
*
First Name
Last Name
Relationship to Child
*
Address
If different than the child's address listed above
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Occupation
*
Email
*
Phone Number
*
(###)
###
####
Work Phone Number
*
(###)
###
####
Place of work & address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Parent/Legal Guardian 2
*
First Name
Last Name
Relationship to Child
*
Address
If different than child's address listed above
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Occupation
*
Phone
*
(###)
###
####
Email
*
Work Phone Number
*
(###)
###
####
Place of work & address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Emergency Contact Name 1
*
First Name
Last Name
Relation to Child
*
Phone
*
(###)
###
####
Emergency Contact Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Emergency Contact Name 2
*
First Name
Last Name
Relation to Child
*
Phone
*
(###)
###
####
Emergency Contact Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Child Release List:
*
Please list anyone, including parents, to whom your child can be released to.
Do you have any concerns with your Child that you want the teachers to be aware of?
*
Child's Alberta Health Care Number
*
Are immunizations up to date?
*
Does your Child have any allergies or medical conditions?:
*
Will your Child have a epipen on site?:
*
Are there any medications administered to your child on a regular basis (other than pain relief, cold/flu, etc.)? If so, please list:
*
Childs Doctor
*
First Name
Last Name
Clinic Name
*
Doctor Phone Number
*
(###)
###
####
Clinic Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
