Teacher Information Sheet - Chestermere Community Playschool printable pdf download

Teacher Information Sheet - Chestermere Community Playschool

Teacher Information Sheet

Child Information:

Name: __________________________________________________________________

Birth Date (mm/dd/yyyy): ___/___/______

Sex: _________________________

Address: ________________________________________________________________

City: _____________________ Province: _________ Postal Code: _________________

Home Phone: _______________________ Alternate Phone: ______________________

Family E-mail Address: ____________________________________________________

Language(s) Spoken: ______________________________________________________

Medical Information

Alberta Health Care No: ___________________________________________________

Family Physician Name: _____________________ Phone Number: ________________

Health Conditions: ________________________________________________________

______________________________________________________________________________

__________________________________________________________________

Allergies: _______________________________________________________________

Medications Administered at Home: __________________________________________

________________________________________________________________________

**If medications need to be administered at school please see the teachers to fill out a

Medication Authorization Form**

Are child’s immunizations up to date? Yes/No

Please provide the teachers some information to help us get to know your child:

Siblings: ________________________________________________________________

Favorite Games/Activity: ___________________________________________________

Favorite Songs: __________________________________________________________

Favorite Toys: ___________________________________________________________

Anything Else: ___________________________________________________________

201 West Chestermere Dr

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Chestermere, AB

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T1X 1B2

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Teacher Information Sheet - Chestermere Community Playschool