Eaglesham Playschool Club

Registration Form
Welcome to Eaglesham Playschool Club! Please complete this form so that we can learn some basic
information about you.

Child’s Information:
Last Name: First Name: M.I.:
Date of Birth: Sex: M F
MM/DD/YYYY
Address:
Address City Province Postal Code
Telephone (Home):

Parent/Guardian Information: Please provide information for at least two people

Last Name: First Name:
Relationship to child:
Address (if different than child):

Address City Province Postal Code

Phone:
Home Work Cell
Are you able to send and receive text messages from cell # provided: Y N
Email: @ .
Your preferred method/best number to reach you:

Last Name: First Name:

Relationship to child:
Address (if different than child):

Address City Province Postal Code

Phone:
Home Work Cell
Are you able to send and receive text messages from cell # provided: Y N
Email: @ .
Your preferred method/best number to reach you:
Health Information:
Physician’s Name: Phone #:
Alberta Health Card #:
Allergies/Medical Conditions:

Emergency Contact Information: (Other than Parent/Guardian listed previously)

Last Name: First Name:
Relationship to child:
Cell or Daytime Phone #:

Contacts: (Please list any other contacts that may pick-up or drop-off your child in the absence of the
parent/guardian/emergency contact listed on this form.)
Last Name: First Name:
Relationship to child:
Cell or Daytime Phone #:

Last Name: First Name:

Relationship to child:
Cell or Daytime Phone #:

Last Name: First Name:

Relationship to child:
Cell or Daytime Phone #:

Agreement Between Parent(s)/Guardian(s) and Eaglesham Playschool Club

I (we) understand that this is a parent participation preschool coordinated by the Eaglesham Playschool
Club. I (we) further understand that the main purpose of this program is to provide a positive environment
in which a wide variety of play experiences will be made available to our children and that the preschool’s
success depends upon the participation and sharing of responsibilities by all families.

As a parent/guardian of a child registered in Eaglesham Playschool Club, I (we) agree to fulfill our
participation and responsibilities in the following ways:
• Pay required fees: $20 registration fee + $500 tuition fee ($520)
• Attend at least 1 parent/teacher meeting to discuss progress of child
• Work in the classroom as an assistant on my assigned days and take responsibility for providing a
trained substitute when necessary (will be determined by teacher)
• Provide a nutritious snack for my child (or class if required)
• Keep my child at home if there are signs of any communicable disease
• Volunteer for a board or committee position
• Participate in fundraising according to school guidelines
• Fulfill duties assigned equally to all for the upkeep of the school facilities

By signing the portion below, I (we) am willing to meet the above requirements of Eaglesham
Playschool Club:

Parent/Guardian Date