Kidopia Early Learning Registration Form

Kidopia Registeration Form

Kidopia Early Learning Registration Form

We are delighted that you are considering Kidopia for your child’s early learning journey. Please take a few moments to complete this registration form so that we can gather all the necessary information to provide the best care for your child. Kindly note that submitting this form does not guarantee enrolment; registration will only be confirmed once the registration fee is paid in full. Thank you for your understanding.

Child Information

Child’s First Name

Child’s Last Name

Child’s Date of Birth

Program Type

Infant & Toddler (0–36 months)

3–5 Group Care / Preschool (30 months–5 years)

Junior Kindergarten (9am-2pm)

Before & After School (6–12 years)

ONLY Before School (6–12 years)

ONLY After School (6–12 years)

Schedule

Full Time

Part Time(4 days/week)

Part Time(3 days/week)

Part Time(2 days/week)

Drop in

Days of the Week

Monday

Tuesday

Wednesday

Thurseday

Friday

Kidopia Location

Start Date:

Parents/Guardians

Parent / Guardian #1 First Name

Parent / Guardian #1 Last Name

Relationship of Parent / Guardian #1 to Child:

Email Address (Parent / Guardian #1)

Phone Number(Parent / Guardian #1)

Address (Parent/Guardian #1)

Address Line 1

Address Line 2

City

Province

Postal Code

Parent / Guardian #2 First Name

Parent / Guardian #2 Last Name

Relationship of Parent / Guardian #2 to Child:

Email Address (Parent / Guardian #2)

Phone Number(Parent / Guardian #2)

Typical Drop off Time:

Typical Pick up Time:

Additional Authorized Person to Pick up/Drop off

Additional Authorized Person to Pick up

Relationship to Child

Auth. Person’s Phone/Mobile

Is there any person who is not authorized to pick up the child? If yes, provide the name.

Emergency Contacts

Emergency Contact #1

Relationship to Child

Phone/Mobile

Emergency Contact #2

Relationship to Child

Phone/Mobile

Out of Town Conact

Relationship to Child

Phone/Mobile

Medical Information

Section 57(2) (a) of the Child Care Licensing Regulation requires licensed child care programs to have
a record of each child’s immunization status.
The completion of this section meets the requirement to maintain a record of children’s medical informtion and immunization
status and will assist in identifying those that may require exclusion in the event of an outbreak of a
communicable disease because they are not immunized.

Child’s Care Card Number

Child’s Doctor Name

Phone

Child’s Dentist Name

Phone

Vaccination Status

Complete Vaccination_Record of Vaccination Attached

Complete Vaccination_Record of Vaccination unavailable

Incomplete Vaccination_My child has had some vaccinations

Incomplete Vaccination_My child has had NO vaccinations

I don’t know

Please Attach the Record of Vaccination. For Example; BC Child Health Passport OR immunization record either in English or any language. Ensure your child’s name and date of birth are written on each page.

Choose File

Does your child require any medications during daycare hours? If yes, please list the medications and instructions for administration

Emergency medication details (e.g., EpiPen, asthma inhaler) Does your child have an EpiPen or inhaler? If Yes, Where is it stored?

Pleas check the box if applicable

Kidopia has the Permission to administer medication as instructed above.

Allergies and Dietary Restrictions

Does your child have any food allergies or dietary restrictions? Please list any known allergies (e.g., food, medication, environmental)

Does your child have any specific food preferences (e.g., vegetarian, halal, gluten-free)?

Other Permission

Do you consent to your child being photographed or videotaped for daycare activities and events?

Yes

Do you give permission for photos/videos to be used on the daycare’s website/social media

Yes

Do you give permission for sunscreen/bug spray application?

Yes

Anything else?

Is there anything else we should know about your child’s needs, habits, or routines?

Kidopia Mission Policies, Schedules, and procedures (Mission Location)

Please read carefully and agree to Kidopia Early Learning Policies, Schedules and Procedure(Mission) and check the box below.

Kidopia Wellington Policies, Schedules, and procedures (Wellington Dr., North Vancouver Location)

Please read carefully and agree to Kidopia Early Learning Policies, Schedules and Procedure(Wellington) and check the box below.

Kidopia Wellington Policies, Schedules, and procedures (Wooddale Dr., North Vancouver Location)

Please read carefully and agree to Kidopia Early Learning Policies, Schedules and Procedure(Wooddale) and check the box below.

Kidopia Wellington Policies, Schedules, and procedures (Windsor Dr., North Vancouver Location)

Please read carefully and agree to Kidopia Early Learning Policies, Schedules and Procedure(Windsor) and check the box below.

I have read and agree to the Kidopia Early Learning Policies, Schedules and Procedures for the location selected above.

Please type your complete name below. By typing your full name below, you agree this serves as your digital signature

Date