Online Admission Form

Name
Gender:MaleFemale
Date of Birth: Age:
Address:

Family Information:

 MotherFather
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.”