Child Care Registration Form Ymca Page 4
Download a blank fillable Child Care Registration Form Ymca in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Child Care Registration Form Ymca with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4Day Nursery Immunization History
FORM TO BE COMPLETED AT THE TIME OF REGISTRATION
Nursery School/Day Care operators are required by the Day Nurseries Act, R.R.O. 1990 Reg. 262, s.33 to
keep a record of immunization on each child enrolled in a program or the parent/guardian’s reason in writing
as to why the child is not immunized. Please note that once your child attends school, additional
documentation is required under the Immunization of School Pupils Act if you choose not to immunize.
Please contact the health unit to discuss your options.
Please complete the following section and attach a photocopy of your child’s immunization record
(ensure child’s name and date of birth are recorded on the record). A copy of this information will be
given to and kept on file by the Hastings & Prince Edward Counties Health Unit. Health Unit staff will review
immunization information on each child enrolled in a Nursery/Day Care program. If your child’s
immunization record is not complete you will be notified by the Health Unit.
Immunization records are NOT automatically provided by your doctor. Please call the Health Unit or
complete the secure electronic form on our website at
when your child
receives an immunization, so that their immunization record can be updated in our database.
Student Information (Please Print)
Date:
yyyy / mm / dd
Child’s Surname:
Please attach a
photocopy of your
child’s Immunization
Given Name:
Record
Date of Birth:
yyyy / mm / dd
M
F
Ontario Health Card Number:
Parent / Guardian:
Mailing Address:
City:
Postal Code:
Phone (H):
Phone (W):
Current Preschool/Daycare:
Previous Preschool/Daycare:
name
city/town
This information is collected under the authority of the Health Protection and Promotion Act R.S.O 1990 c.H.7., s.4 and the Day Nurseries Act R.R.O. 1990 Reg. 262, s.33. The personal health
information collected on this form will be used to maintain immunization records and to monitor the use of vaccines for public health purposes. Questions regarding the collection and use of
personal health information should be directed to the FOI Coordinator, Hastings & Prince Edward Counties Health Unit, 179 North Park St., Belleville, ON K8P 4P1, 613.966.5513 or 800.267.2803.
IMM-153
2011/10/07
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business