Application Form

We would love to welcome your child at Dartmouth Day Care. To get started please complete our application form below. If you have any questions please call us on 902-434-2865 for more information

Child's Name

Date of Birth

Address

Telephone

Parent / Guardian 1

Name

Telephone

Occupation

Employer's Name

Employer's Telephone

Parent / Guardian 2

Name

Telephone

Occupation

Employer's Name

Employer's Telephone

Emergency Contact

Name

Telephone

Relationship

Other Information

Family Doctor's Name

Family Doctor's Telephone

Child's Health Card Number

Does your child have any allergies?

What are your child’s personality traits? I.e.-do they prefer to play alone or in a group? Do they get upset easily? Can they be comforted easily?

What methods of discipline do you use?

Does he/she have a good appetite? Any specific likes/dislikes?

Does he/she have any specific fears?

Does he/she have any specific sleeping habits?

Can he/she attend to himself/herself in the bathroom?

Has your child been in day care before?

Please read carefully and accept the following terms:

Daily Fee

I understand that the daily fee charged is to be paid whether my child misses time or not

Outside Expeditions

I am willing for my child to go outside and on outside expeditions with adequate supervision and have read your field trip policy

Medical Attention

I am willing for my child to have medical attention or to be taken to the hospital in case of emergency

Day Care Rules

I have read the brochure on the day care and understand it, therefore, will endeavour to abide by the rules that are explained

Behavioural Guidance Policy

I have read your behavioural guidance policy and your obligation to report suspected child abuse

Parent Policy

I have received my own copy of the parent policy

Behaviour Policy

I have received my own copy of the behaviour policy

Important

My child can be released from the day care to the following people and i understand that i am to inform the staff if someone other than the people listed below will be picking my child up: (please give phone numbers and relationship to the child)

Authorized Person 1 Name

Authorized Person 1 Relation

Authorized Person 1 Phone

Authorized Person 2 Name

Authorized Person 2 Relation

Authorized Person 2 Phone

Authorized Person 3 Name

Authorized Person 3 Relation

Authorized Person 3 Phone

Authorized Person 4 Name

Authorized Person 4 Relation

Authorized Person 4 Phone

I understand that I have to pay any or all applicable fees per month and that failure to pay the account may result in referral of the delinquent account to a collection agency, action against me in small claims court or refusal to provide continued service.

I agree that the Executive Director from Dartmouth Day Care Centre may contact other centres at which my child has been enrolled to determine if my account was in good standing at the time of my withdrawal.

I understand that if I have a delinquent account at Dartmouth Day Care Centre this information may be passed along to another centre to which may not accept my child until I satisfy this obligation.

I understand that if I have difficulty meeting my financial obligations I must contact the Executive Director and discuss ways in which these obligations may be met.

Signed:

Date:

Witness:

Date: