Whistle Stop Co-op Preschool Online Registration

• Child Information

  * required fields
• * Last Name:
• * First Name:
• * Middle Name:
• * Date Of Birth (YYYY / MM / DD)
• * Days Of Care: 1 day2 days3 days
• * Street Address:
• Unit / Apt:
• * City /Town:
• * Postal Code:

• Parent / Gaurdian Information

• * Last Name (1):
• * First Name (1):
• Last Name (2):
• First Name (2):
• * Street Address:
• * Home / Cell Phone #:
• Work Address:
• Work Number:
• * Email:

• Emergency contact if parent cannot be reached in case of an emergency during hours of care.

• * Name:
• * Home Address:
• * Telephone:

• Name of persons to whom the child may be released.

• * Name 1:
• Name 2:
• Name 3:

• Family Physician

• * Name:
• * Address:
• * Telephone:
• * Child's previous history of communicable diseases:
• * Dates:

• Next Step (Immunization Form)

• Child's Information

• Last Name:
• First Name:
• Middle Name:
• Date Of Birth (YYYY / MM / DD)
• Sex: MaleFemale
• Ontario Health Card:
• Version Code:
• Street Address:
• Unit / Apt:
• City /Town:
• Postal Code:
• Name of Doctor:
• Doctor's Phone #:

• Parent / Gurdian Information

• Last Name (1):
• First Name (1):
• * Relationship to Child (1):
• Last Name (2):
• First Name (2):
• Relationship to Child (2):
• Home / Cell Phone #:
• Work Phone #:

• Next Step (General Info Form)

  Prev Step (Registration Information)

• General Information

• Child's Allergies ( Certain allergies may require additional forms to be compelted):
• Medical Treatment, Drug or medication to be administered during the hours the child is receiving care ( written and signed instruction must be provided by a parent of the child ):
• Special requirements for diet, rest or exercise ( written and signed instruction must be provided by a parent of the child ):
• Please comment on your child's development, giving information that will be usefil in the provision of care (e.g. child's habits, favourite activities, routines, fears etc. ):
• Other Information:
• Please tell us how you heard about our Pre-school:

• Next Step (Confirm and Submit)
  Prev Step (Immunization Form)

• Registration Complete - Please Click below to submit your registration form.

• Submit