Registration Form
The Seed Daycare
2611 Ellwood Drive SW, Edmonton T6X0P7
(587) 710-8947
[email protected]
Child Information
First Name *
Last Name *
Goes By (Alias)
Date of Birth *
Gender *
Male
Female
Is there a Custody Agreement? *
Yes
No
Is Privacy Required for Child? *
Yes
No
Is Immunized? *
Yes
No
Subsidy Status *
Subsidy is approved
I have applied for subsidy
I will apply for subsidy
I need help applying for subsidy
I do not plan to apply for subsidy
School *
Not in school
Attending kindergarten
Attending grade 1 to 6
Enrolment
Start Date *
Enrolment Type *
Full-Time
Part-Time
Drop-In
Medical
Doctor Name
Doctor Phone
Health Care ID
Is there any ongoing medication? *
Yes
No
Medical Concerns
Allergies
Diet Restrictions
First Parent
First Name *
Last Name *
Relation to Child *
Father
Mother
Guardian
Gender *
Male
Female
Phone *
Email *
Address *
City *
Postal Code *
Is this an Emergency Contact? *
Yes
No
Is Parent Authorized for Pickup? *
Yes
No
Does Child live with this Parent? *
Yes
No
Show Billing Info to this Parent? *
Yes
No
Work Details
Occupation
Work Address
Work Phone
Employer Phone
Bank Details
Account Number
Bank Code
Transit Number
What is the Fee Share (in %) for this Parent? *
Second Parent
First Name
Last Name
Relation to Child
Father
Mother
Guardian
Gender
Male
Female
Phone
Email
Address
City
Postal Code
Is this an Emergency Contact?
Yes
No
Is Parent Authorized for Pickup?
Yes
No
Does Child live with this Parent?
Yes
No
Show Billing Info to this Parent?
Yes
No
Work Details
Occupation
Work Address
Work Phone
Employer Phone
Bank Details
Account Number
Bank Code
Transit Number
What is the Fee Share (in %) for this Parent?
Emergency Contacts
Emergency Contacts *
Notes
By submitting, I authorize The Seed Daycare to send information via SMS, Call, WhatsApp, E-mail or at Postal Address and I agree to
Privacy Policy
.
Submit