Teacher Information Sheet - Chestermere Community Playschool (Page 2 of 2) in pdf

Teacher Information Sheet - Chestermere Community Playschool Page 2

Parent/Guardian Information:

Mother/Guardian Full Name: _______________________________________________

Phone: (home)________________ (work)_________________ (cell)________________

Address (if different than child): _____________________________________________

E-mail Address: __________________________________________________________

Language(s) Spoken: ______________________________________________________

Father/Guardian Full Name: ________________________________________________

Phone: (home)________________ (work)_________________ (cell)________________

Address (if different than child): _____________________________________________

E-mail Address: __________________________________________________________

Language(s) Spoken: ______________________________________________________

Emergency Contact Information (other than parent): ***Must be LOCAL***

Contact Name: ___________________________________________________________

Relationship to child: ______________________________________________________

Language(s) Spoken: ______________________________________________________

Phone: (home)________________ (work)_________________ (cell)________________

Address: ________________________________________________________________

City: _____________________ Province: _________ Postal Code: _________________

Parent Signature:__________________________________ Date:___________________

Administrative Use Only:

3am

3pm

4am

4pm

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 Page 2