MTJB Registration Form Child’s Information Name: Address: Gender: Male Female City: Date of Birth: Postal (MM/DD/YY) Code: School Child Attends: Parent/Guardian Information Father Stepmother Partner Father Stepmother Partner Mother Stepfather Legal Guardian Mother Stepfather Legal Guardian Name: Name: Address: Address: City: City: Postal Code: Postal Code: Email Address: Email Address: Home Phone: Home Phone: Alternate Phone: Alternate Phone: Work Phone: Work Phone: Business Name: Business Name: Business Address: Business Address: Position: Position: If Legal Guardian If Legal Guardian – – Relationship to Child: Relationship to Child: Special Family Special Family Circumstances: Circumstances: EMERGENCY CONTACTS NAME ADDRESS City RELATIONSHIP TO PHONE NUMBER ALTERNATE CHILD PHONE NUMBER 1 2 3 4 Signatures Parent/Legal Guardian: Parent/Legal Guardian: Date: Date: For Office Use Only Date: ___________ __ Kinder Start_____ End______ __ Website Centre: Approval For: Approval For: Days of Care: __ Photos _Sunscreen __M __T__W __Th __F __ Class Facebook Page _Bug Spray Program: __Scheduled __Casual __ Videos Sanitizer __ Infant __Toddler __HiMama _Lip balm Hours of Care Req’d: __ Jr __ Sr Preschool
MTJB Registration Form Child’s Information Name: Address: Gender: Male Female City: Date of Birth: (MM/DD/YY) Postal Code: School Child Attends: Parent/Guardian Information Father Stepmother Partner Father Stepmother Partner Mother Stepfather Legal Guardian Mother Stepfather Legal Guardian Name: Name: Address: Address: City: City: Postal Code: Postal Code: Email Address: Email Address: Home Phone: Home Phone: Alternate Phone: Alternate Phone: Work Phone: Work Phone: Business Name: Business Name: Business Address: Business Address: Position: Position: If Legal Guardian – Relationship to Child: If Legal Guardian – Relationship to Child: Special Family Circumstances: Special Family Circumstances: EMERGENCY CONTACTS NAME ADDRESS City RELATIONSHIP TO CHILD PHONE NUMBER ALTERNATE PHONE NUMBER 1 2 3 4 Signatures Parent/Legal Guardian: Parent/Legal Guardian: Date: Date: For Office Use Only Date: ___________ Centre: Program: __ Infant __Toddler __ Jr __ Sr Preschool __ Kinder Days of Care: __M __T__W __Th __F __Scheduled __Casual Hours of Care Req’d: Start_____ End______ Approval For: __ Photos __ Class Facebook Page __ Videos __HiMama __ Website Approval For: _Sunscreen _Bug Spray Sanitizer _Lip balm
mtjb_registration_form_2018_-__new_revised.docx