Milestone Education Center Early Learning & Inclusive CarePlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Please tick the age group you are enrolling your child in: *Infant (3–12 months)Toddler (1–3 years)Inclusive Program (All ages)Kindergarten (3–6 years)SECTION 1: CHILD’S DETAILSFull Name *FirstLastDate of Birth *Gender *FemaleMaleHome Address *Address Line 1CityState / Province / Region--- Select country ---AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryStarting Date *SECTION 2: PARENT/GUARDIAN DETAILSPrimary Contact:Name *FirstLastRelationship to Child *Phone *Email *Emergency Contact (other than parent):Name *FirstLastPhone *Relationship *SECTION 3: HEALTH & DEVELOPMENTAllergies: If 'Yes', list: *YesNoList Allergies *Medical conditions or medications: If 'Yes', list: *YesNoList medical condition or medication required *Is your child immunized? If 'Yes', attach record *YesNoAttach Record * Click or drag a file to this area to upload. Special needs, support required, or therapies involved: *SECTION 4: GROUP-SPECIFIC REQUIREMENTSINFANTS (3–12 MONTHS)Please Bring: 2–3 sets of spare clothes (labelled) Baby formula or breast milk (clearly labeled) Bottles Nappies, wipes, and barrier cream (e.g., Sudocrem) Blanket and pillow Preferred nap schedule (if any): Feeding instructions: Carry bag for dirty clothes TODDLERS (1–3 YEARS)Please Bring: Spare clothes (labelled) Lunchbox and drink bottle Nappies and wipes (if not yet potty trained) Pillow and blanket for nap time Personal toy (optional – for comfort) Potty training status:In ProgressTrained Is Address PARENT/GUARDIAN Preferred learning or play style: INCLUSIVE PROGRAM (ALL AGES)Please share: Diagnosis (if any): Type of support needed (e.g., speech therapy, visuals, routines):Communication method: VerbalSign LanguageHand GesturesOtherPlease ListTriggers/soothing techniques used at home: Staff may contact you for an individual education/behavior plan. KINDERGARTEN (4–6 YEARS)Please Bring: Backpack with lunchbox Drink bottle Change of clothes Small pillow for rest time Observations: SECTION 5: DOCUMENT CHECKLISTPlease attach copies of the following: Birth Certificate of Child * Click or drag a file to this area to upload. Parent/Guardian Photo ID * Click or drag a file to this area to upload. 1 Passport-Sized Photo of Child * Click or drag a file to this area to upload. SECTION 6: CONSENT & SIGNATUREDeclaration *I hereby declare that the information provided is true and complete. I agree to follow center policies and give permission for my child to participate in all age-appropriate activities.Signature of Parent/Guardian: Clear Signature Upload Electronic Signature Click or drag a file to this area to upload. (optional)Date: *Submit Registration
