BALFOUR PRESCHOOL REGISTRATION

1. Please Provide Child Name

Student Name*

Legal First Middle Legal Last

Preferred First Name Preferred Last Name

2. Additional Child Information

Date Of Birth*

Gender*

3. Emergency Contact Person (other than parent)

*

Name Email Address Phone Relationship to student

4. Medical Information

BC Medical Number*

I don't have a BC Medical Number

Have you recently applied for a BC medical number?*

Yes
No

Provide medical number for previous province*

Are there any allergies?*

Yes
No

Are their allergies severe?*

Yes
No

Please fill out the Allergy severity form below and attach it with the rest of the documentation at the end of this form.
Allergy Severity Form

Any medical concerns?*

Yes
No

Please fill out the Medical Information form below and attach it with the rest of the documentation at the end of this form.
Medical Information Form

Provide family doctor's information

Family Doctor's name Family Doctor's phone/email

5. Parental Permission

I permit Balfour Community Preschool staff to contact a medical practitioner or ambulance in case of accident or illness if parent cannot be reached.*

Yes
No

I permit my child's name and photo to be used in school publications (ie. school newsletters), both electronic and paper.*

Yes
No

I permit my child to be included in any media coverage of a school event.*

Yes
No

The following individuals have my permission to pick up my child(ren).

6. Agreement

I/We are willing to support the school, the decisions of the Principal and the regulations passed by the school board.*

Yes
No

Please type your full legal name to the above statement. Typed names suffice as handwritten signatures.