Registration Form                                        Date of registration

Child's Full Name: __________________________________   Birth Date: __________________

Address: _________________________________________   Home Phone: _______________

City: ____________________________   State: _______________ Zip Code: ______________

Nickname: ____________________________________________________________________

Mother's Full Name: _______________________________   Home Phone: _________________

Address: _____________________________________________________________________

Occupation: ____________________________________  Work Phone: ___________________

Name of Employer: ______________________________   Cell Phone: ____________________

Business Address: _______________________________  City: _________________________

Father's Full Name: ______________________________  Home Phone: ___________________

Address: _____________________________________________________________________

Occupation: ___________________________________ Work Phone: ____________________

Name of Employee: _____________________________  Cell Phone: _____________________

Business Address: ______________________________City: ___________________________

Parents are:
___Married,    ___Living Together,   ___Divorced,   ___Separated,   ___Widowed,   ___Single

Parent/Guardian with legal custody ________________________________________________
It is helpful to furnish a copy of the divorce decree or custody agreement which will be kept in your child's file and all information will be confidential.


Emergency Contracts
        (Any individual other than parent or guardian that is within 30 mile radius of daycare)

Primary Emergency Contact: _____________________________________________________

Home Phone: ____________________________  Work Phone: _________________________

Please indicate which number is best for the hours your child is in my care. _________________

Relationship to Child: __________________________________________________________

Address: _____________________________________________________________________

Secondary Emergency Contact: ___________________________________________________

Home Phone: ____________________________  Work Phone: __________________________

Allergies / Special Needs or Instructions / Medications: _________________________________


Name of other school child attends: ___________________________ Phone: _______________

Immunization records: _____on file,  _____complete,   ____incomplete

Registration Fee:  ________________ due at time of signing

Parent's Signature                                                                                                                                             Manager's Signature

Madical information:

Child’s Physician’s Name:_____________________________________Phone #:__________ 


Hospital to take child in case of an emergency:________________________________

Dentist’s Name (either Child’s or Parent’s): __________________________________ 

Address:______________________________________________Phone #:_________

Care card number #:______________________ 

 Special Conditions, Disabilities,

Allergies, or Medical Information for Emergency Situations: _____________________________________________________________________ _


 Parent/Legal Guardian Consent and Agreement for Emergencies As parent/legal guardian, I give consent to have my child receive first aid by facility staff, and, if necessary, be transported to receive emergency care. I understand that I will be responsible for all charges not covered by insurance. I agree to review and update this information whenever a change occurs and at least once a year.

Date:__________        Parent/Guardian Signature____________________________________

New steps Childcare 7590-127 a street Surrey B.C

Parent Contract


Fees are paid prior to the month and stay the same regardless of how many days are in the month.  Parents are required to submit a series of 6 month post-dated cheques for the first of each month.  This will avoid paying late charges of $2 per day, if the fees are not paid by the first of the month. Cheques or bank drafts are preferred.  Receipts are given so please keep them safe for your tax purposes.  All N.S.F. cheques are subject to a $20 charge.  If fees are not paid, care will not be provided to your child and your space could be filled.

Centre Closures

New Steps childcare will be closed for all statutory holidays, and two week winter break also two week spring break. The monthly fee is still the same as staff must also receive pay for statutory holidays. Our fees will be on yearly basis.

Change of Information

It is the responsibility of the parent to inform the centre in writing of any changes that should be made to their child’s registration form.  For example: change of pick up persons, new allergies, new address or phone number, etc.


Parents are required to pay a $25 registration fee at the time or registering their child.  Please plan some time for spending with your child at the centre before he/she starts full time daycare (if you want).


Parents agree not to send their child to the centre with any communicable disease or illness (continuous cough, red throat, unexplained rashes, swollen glands, head or stomach aches, fevers, vomiting and diarrhea). The centre must be informed if your child contacts any illness.  Each and every child must be well enough to participate in the centre’s daily activities (both indoor and outdoor).  Parents will be required to have their doctor sign a release form before their child can return to the centre, if the child has been away with a contagious disease.  Parents will be called to pick up their child if they are not well.


The staff at New Steps Childcare are not permitted, or authorized to administer any medication, unless prescribed by a doctor and dispensed by a pharmacist.  Please do not ever send medication in your child’s lunch box.  The staff must be informed and a medication form must be signed by the parent.  The medication is then kept in a locked box, so that no other child could come in contact with it.


Due to health regulations, parents must supply the children with their lunches.  We ask that these foods be nutritional.  Allergies must be known as special treats may be given at party celebrations.


Withdrawal requires a full month’s notice in writing which must be given the first of the month.  Failure to give one month’s notice will result in the parent being required to pay the full month’s fee. 

Safety policies/Rules

 When parents will come to drop their child, they need to be very careful in bad weather. If there is any slip or fall happen the owner of the property(7590-127 A Street) or New Steps Child care will not be responsible for that. So please be very careful when will you come to drop your child at school. Take care of you and your child. You will not be able to sue the owner as per you signed the contract and advance notice in starting.                                              

I/We __________________________________ understand the policies of New Steps Child Care Centre and agree to abide by them.


Signature of parent/ Guardian                                                                                                       Signature of the manager of Childcare         




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