Elbow Academy - Registration

Child Information

STUDENT PHOTO ^*

Upload a recent photo of student

JPEG, PNG or JPG only Minimum size: 200x200

Admission Year ^*

Admission to program

First Name *

Last Name

Date of Birth *

Gender ^* Male Female

Confirmation Email *

Address *

City/Town *

Postal Code *

School Information - Kindergarten (If Applicable)

Is the child enrolled in school?

Yes No

Verification of Child Identity:
(please select which document and provide a copy)

Identity Document *

Upload Identity Document (PDF, JPG, JPEG, PNG)

Parent/Guardian 1

First Name *

Last Name

Relation to Child *

Email Address *

Phone *

Work Phone

Parent/Guardian 2

First Name *

Last Name

Relation to Child *

Email Address *

Phone *

Work Phone

Emergency Contact (Must reside within 1 hr travel distance, cannot be parent)

Name of Contact 1 *

Relation to Child *

Phone *

Work Phone

Name of Contact 2

Relation to Child

Phone

Work Phone

Releasing Child (pick up person must be 18 years or older and must have picture identification upon initial pick up)

To whom may we release the child for pick ups?

Is anyone NOT allowed to access the child? (If this is a parent, documentation is required)

Previous Childcare

Has the child been enrolled in a childcare facility before?

Yes No

Alberta Health Number (If non-Alberta Health Number please provide ASAP)

Child Immunization Record

Is the child's immunization up to date?

Yes No

Allergy

Does the child have any allergies?

Yes No

Health Conditions

Does the child have any health conditions?

Yes No

Does the child take any medications regularly?

Yes No

Enrollment

Apply Online

Child Information

STUDENT PHOTO ^*

School Information - Kindergarten (If Applicable)

Verification of Child Identity:
(please select which document and provide a copy)

Parent/Guardian 1

Parent/Guardian 2

Emergency Contact (Must reside within 1 hr travel distance, cannot be parent)

Releasing Child (pick up person must be 18 years or older and must have picture identification upon initial pick up)

Previous Childcare

Alberta Health Number (If non-Alberta Health Number please provide ASAP)

Child Immunization Record

Allergy

Health Conditions

Allergy	Symptom	Medication

Enrollment

Apply Online

Child Information

STUDENT PHOTO *

School Information - Kindergarten (If Applicable)

Verification of Child Identity: (please select which document and provide a copy)

Parent/Guardian 1

Parent/Guardian 2

Emergency Contact (Must reside within 1 hr travel distance, cannot be parent)

Releasing Child (pick up person must be 18 years or older and must have picture identification upon initial pick up)

Previous Childcare

Alberta Health Number (If non-Alberta Health Number please provide ASAP)

Child Immunization Record

Allergy

Health Conditions

STUDENT PHOTO ^*

Verification of Child Identity:
(please select which document and provide a copy)