Online Admission Form

    Name

    Gender:

    MaleFemale

    Date of Birth:

    Age:

    Address:

    Family Information:

     

    Mother

    Father

    Parent's Name

    Telephone Number

    Cell Number

    Email Address

    Office Address

    Office Number

     

     

    EMERGENY CONTACT INFORMATION:-

    In the event of emergency, we always attempt to contact the parents first, using the information given by the parents. However, in

    the event neither parents reachable, please provide two alternative emergency contacts available during the day.

     

    ALTERNATIVE CONTACT NO 1

    ALTERNATIVE CONTACT NO 2

    PERSON’S NAME

    RELATIONSHIP TO THE CHILD

    DAY TIME TELEPHONE NUMBER

    CELL PHONE NUMBER

    DAY TIME ADDRESS

     

     

    Persons Authorised to Pick- up Your Child.

    In the event that you are unable to pick up your child at the designated time, you may send someone else. Please advise the teacher in advance, when possible, when using this option and ensure that the person can be at the play school at the required time.

     

    NAME

    RELATIONSHIP TO THE CHILD

    PERSON # 1

    PERSON # 2

    PERSON # 3

     

     

    CHILD’S HEALTH INFORMATION: -

    Is your child’s immunization up to date?

    YesNo

    Does your child have any allergies?

    Does your child require any medications?

    Note: You will be required to complete a “Medical Administration Form” form detailing how to administer the medication, if the medication is required to be administered in-class, including administration in the case of an emergency (e.g. Epi-pen). Please talk to the teacher

    Has your child ever had an epileptic seizure?

    Are there any problems with vision, hearing or speech?

    Are there any special medical, physical, or emotional needs of which the staff/school should be made aware?

    Please list any major childhood illnesses your Child has contracted.

    Does your child routinely have Stomach-aches?

    YesNo

    Earaches?

    YesNo

    Colds?

    YesNo

    Has your child had any serious accidents or operations?

    Please Select characteristics below that generally describe your child:

     

    “I acknowledge that I have read the ORGANIC KIDS admission form, which summarizes the Playschool’s rules and regulations.”

     

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