Preschool/daycare Student Registration Form (Page 3 of 4) in pdf

Preschool/daycare Student Registration Form Page 3

Revised May 2016

Sacred Heart Preschool/Daycare

Medical Information

Doctor: _____________________________

Phone: ________________________

Address: __________________________________________________________________

Care Card Number: __________________________________________________________

Medical problems or allergies: __________________________________________________

My child has been immunized:

Yes _____

No _______

Emergency Consent:

It is the policy of Sacred Heart Preschool/Daycare to notify a parent when a child is ill or needs

medical attention. Occasionally, we cannot contact a parent and may need to get immediate

help for the child. Our procedure is to have the child transported to the nearest emergency

service. Please sign below giving the staff at Sacred Heart Preschool/Daycare consent to take

appropriate action on behalf of your child.

I hereby give permission/consent for my/our child _____________________________ to be

taken to the nearest emergency centre by ambulance if necessary if I/we cannot be contacted.

I further agree to pay all costs incurred for transport.

Parent/Guardian Name: _______________________

Signature: __________________________________

Date: _______________________

Page 3 of 4

Preschool/daycare Student Registration Form Page 3